Quality Improvement

Quality improvement (QI) uses quantitative and qualitative methods to improve the effectiveness, efficiency, and safety of service delivery processes and systems, as well as the performance of human resources in delivering products and services.

The fundamental concept underlying improvement is that a system left unchanged can only be expected to continue to produce the same results. To achieve better performance, one must change the system in ways that enable it to produce the improved result. In health care, improvement science emphasizes changes in health care service delivery processes and systems in ways that will enable the implementation of high-impact, evidence-based interventions to achieve better results. The approach also identifies unnecessary, redundant, or incorrect parts of processes and then changes them to yield streamlined and efficient care delivery.

URC has over 30 years of experience applying improvement methods to health care and has demonstrated that significant improvements in health care quality are attainable in even the most resource-constrained settings. Our approach to health care improvement applies the main principles of QI:

Focusing on the client,
Involving teams of health workers in testing changes to make health care better, and
Making changes to processes and systems of care delivery to yield improvement.

Building on traditional approaches to making the content of health care more effective through evidence-based standards and guidelines, URC focuses improvement methods on strengthening health care delivery processes, thereby achieving much greater impact. Successful changes to improve processes and systems of care are then spread throughout the health system, using proven strategies to enable implementation of the innovations.

URC applies a range of approaches and methodologies to improve the quality of care in low- and middle-income countries. Our assistance has included national quality policy and program design; system and process redesign; regulatory strategies such as accreditation, integrating continuous quality improvement within district health management; and collaborative improvement approaches. Working with partners at the national, sub-national, and facility levels, URC has designed, introduced, and ensured implementation of clinical guidelines and standards, monitoring and assessment methodologies, improved training approaches, and effective job aids that have contributed to sustainable improvements in quality of care and improved interpersonal communications and patient satisfaction.

Adapting the Collaborative Improvement Model to Settings in Low- and Middle-income Countries

One of URC’s most significant advances is adapting the collaborative improvement model to the realities of resource-constrained settings. Learn more here.

Developing Health Care Accreditation Systems

URC also improves the quality and safety of health care services by helping countries establish national accreditation systems, develop standards, conduct certification courses for health care professionals, and prepare facilities and programs for accreditation. Learn more here.

Applying Improvement Methods to Chronic Conditions Care

URC’s Quality & Performance Institute is taking a leadership role in redesigning care processes to shift some of the focus from acute care to care for chronic conditions. Learn more here.

Current Projects

HIV and AIDS Comprehensive Care Initiative (HACCI)
Funded By: US Centers for Disease Control and Prevention through the President's Emergency Plan for AIDS Relief
Project Duration: 2008 to present

Building Human Resource Capacity to Support Prevention, Care, and Treatment: Strategic Information and Other HIV/AIDS Programs
Funded By: US Centers for Disease Control and Prevention
Project Duration: 2008 to present

Better Health Services (BHS)
Funded By: US Agency for International Development
Project Duration: 2009 to present

Essential Obstetric and Newborn Care (EONC) Networks Project in Cotopaxi, Ecuador
Funded By: US Agency for International Development
Project Duration: 2009 to present

Strengthening TB Case Detection and Treatment and TB-HIV Coordinated Activities
Funded By: URC
Project Duration: 2007 to present

Implementation Support for Non-Communicable Diseases and Injuries
Funded By: Millennium Challenge Corporation
Project Duration: 2009 to present

South Africa Tuberculosis Program
Funded By: US Agency for International Development
Project Duration: 2009 to present

Increasing Access to HIV Testing and Counseling
Funded By: US Centers for Disease Control and Prevention
Project Duration: 2006 to present

HIV/AIDS and Tuberculosis Laboratory Support
Funded By: US Centers for Disease Control and Prevention
Project Duration: 2009 to present

Maternal and Newborn Health in Ethiopia Partnership (MaNHEP)
Funded By: Subaward from Emory University with funding from the Bill & Melinda Gates Foundation
Project Duration: 2009 to present

Translating Research into Action (TRAction) Project
Funded By: US Agency for International Development
Project Duration: 2009 to present

Technical Assistance and Support Contract 3: Global Health (TASC3 Global Health)
Funded By: United States Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Afghanistan
Funded By: US Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Bolivia
Funded By: US Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Ecuador
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Ethiopia
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Guatemala
Funded By: US Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Honduras
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Indonesia
Funded By: US Agency for International Development
Project Duration: 2009 to present

USAID Health Care Improvement Project (HCI) | Cote d’Ivoire
Funded By: United States Agency for International Development
Project Duration: 2008 to present

USAID Health Care Improvement Project (HCI) | Global
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Kenya
Funded By: The President’s Emergency Plan for AIDS Relief through the US Agency for International Development
Project Duration: 2009 to present

USAID Health Care Improvement Project (HCI) | Mali
Funded By: US Agency for International Development
Project Duration: 2009 to present

USAID Health Care Improvement Project (HCI) | Mozambique
Funded By: The President’s Emergency Plan for AIDS Relief through the US Agency for International Development
Project Duration: 2009 to present

USAID Health Care Improvement Project (HCI) | Nicaragua
Funded By: United States Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Niger
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | South Africa
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Swaziland
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Tanzania
Funded By: US Agency for International Development
Project Duration: 2007 to present

USAID Health Care Improvement Project (HCI) | Uganda
Funded By: US Agency for International Development
Project Duration: 2007 to present

Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN)
Funded By: US Agency for International Development (USAID)
Project Duration: 2010 to present

PrevenSIDA
Funded By: United States Agency for International Development
Project Duration: 2010-present

USAID Health Care Improvement Project (HCI) | Senegal
Funded By: US Agency for International Development
Project Duration: 2010 to present

Developing Strategies in the Central America and Panama Region to Strengthen Reponses to the HIV Epidemic
Funded By: Centers for Disease Control and Prevention (CDC)
Project Duration: 2010 to present

TB CARE II
Funded By: United States Agency for International Development (USAID)
Project Duration: 2010 to present

USAID Primary Health Care Project in Iraq (PHCPI)
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

Diagnosis and Management of Severe Febrile Illness: Tibu Homa
Funded By: US Agency for International Development
Project Duration: 2011 to present

Improving TB Detection and TB-HIV Services Integration
Funded By: URC
Project Duration: 2011 to present

USAID Health Care Improvement Project (HCI) | Malawi
Funded By: The President’s Emergency Plan for AIDS Relief through the US Agency for International Development
Project Duration: 2011 to present

USAID Health Care Improvement Project (HCI) | Nigeria
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

USAID Health Care Improvement Project (HCI) | Zambia
Funded By: The President’s Emergency Plan for AIDS Relief through the US Agency for International Development
Project Duration: 2011 to present

Control and Prevention of Malaria (CAP-Malaria) Project
Funded By: US Agency for International Development Regional Development Mission for Asia (USAID RDMA)
Project Duration: 2011 to present

Georgia Tuberculosis Prevention Project (TPP)
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

USAID Health Care Improvement Project (HCI) | Georgia
Funded By: US Agency for International Development (USAID)
Project Duration: 2011 to present

USAID Health Care Improvement Project (HCI) | Haiti
Funded By: The President’s Emergency Plan for AIDS Relief through the US Agency for International Development
Project Duration: 2012 to present

Nutri-Salud: Community Nutrition and Health Project
Funded By: US Agency for International Development
Project Duration: 2012 to present

Production for Improved Nutrition
Funded By: US Agency for International Development (USAID)
Project Duration: 2012 to present

Past Projects

Malaria Control in Cambodia (MCC) Project
Funded By: US Agency for International Development
Project Duration: 2007-2011

Benin Integrated Family Health Project (Projet Intégré de Santé Familiale, PISAF)
Funded By: US Agency for International Development and the President’s Malaria Initiative through USAID for malaria activities
Project Duration: 2006–2012

Promoting Malaria Prevention and Treatment (ProMPT)
Funded By: US Agency for International Development through the President’s Malaria Initiative
Project Duration: 2009-2013

USAID Health Care Improvement Project (HCI) | El Salvador
Funded By: US Agency for International Development
Project Duration: 2009 to 2012

USAID Health Care Improvement Project (HCI) | Namibia
Funded By: US Agency for International Development
Project Duration: 2008-2012

USAID Health Care Improvement Project (HCI) | Russia
Funded By: US Agency for International Development (USAID)
Project Duration: 2007-2012

USAID Health Care Improvement Project (HCI) | Vietnam
Funded By: US Agency for International Development
Project Duration: 2007 to March 2011

Community-Based Maternal, Neonatal, and Child Health Innovation
Funded By: US Agency for International Development through a sub-award from ChildFund International
Project Duration: 2009 to 2012

Infant and Young Child Nutrition (IYCN)
Funded By: US Agency for International Development
Project Duration: 2006-2011

Jordan Healthcare Accreditation Project (JHAP)
Funded By: US Agency for International Development
Project Duration: 2007 - 2013

Integrated Infectious Disease Capacity Building Evaluation (IDCAP)
Funded By: Accordia Global Health Foundation
Project Duration: 2008-2012

Food and Nutrition Interventions (NuLife)
Funded By: US Agency for International Development through the President’s Emergency Plan for AIDS Relief
Project Duration: 2008-2011

Improving Primary Health Care in Albania I and II (Pro Shëndetit)
Funded By: US Agency for International Development
Project Duration: 2003–2009

Quality Improvement Initiatives at the Acid Survivors Foundation
Funded By: US Agency for International Development
Project Duration: 2007-2008

Nongovernmental Organization Service Delivery Program in Bangladesh
Funded By: US Agency for International Development/Bangladesh
Project Duration: 2002-2006

Benin Integrated Family Health Project (PROSAF)
Funded By: US Agency for International Development/Benin
Project Duration: 1999-2006

Health Systems Strengthening (HSS)
Funded By: US Agency for International Development/Cambodia
Project Duration: 2002-2008

Creating a Reference Standard to Determine Central Line Associated Bloodstream Infection Rates (CLABSI)
Funded By: US Centers for Disease Control and Prevention (CDC)
Project Duration: 2009 to 2010

Dominican Republic Child Survival Project
Funded By: US Agency for International Development/Dominican Republic
Project Duration: 1991-1993

Egypt Quality Assurance Consultancy
Funded By: US Agency for International Development/Egypt
Project Duration: 1994

El Salvador Health Systems Support Project I and II
Funded By: US Agency for International Development/El Salvador
Project Duration: 1987–1996

El Salvador Strengthening Health Project Technical Assistance and Support Contract 2 (TASC2)
Funded By: US Agency for International Development
Project Duration: 2006–2009

Eritrea Technical Assistance and Support Contract 2 (TASC2)
Funded By: US Agency for International Development/Eritrea
Project Duration: 2003–2006

The Maram Project: Healthier Palestinian Families
Funded By: US Agency for International Development
Project Duration: 2002-2004

Health Planning and Health Delivery Systems
Funded By: US Agency for International Development
Project Duration: 1983-1990

Integrated Management of Childhood Illness Computer-Based Learning Tool
Funded By: World Health Organization
Project Duration: 2001-2002

Primary Health Care Management Advancement Program
Funded By: The Aga Khan Foundation
Project Duration: 1991-1993

Partnerships for Health Reform Project and Partners for Health Reformplus
Funded By: US Agency for International Development
Project Duration: 1995–2005

Primary Health Care Operations Research Project (PRICOR) I and II
Funded By: US Agency for International Development
Project Duration: 1981–1991

Maternal and Child Health: Technical Assistance and Support Contract (TASC)
Funded By: US Agency for International Development
Project Duration: 1998–2003

Water and Sanitation for Health
Funded By: US Agency for International Development
Project Duration: 1988–1994

Quality in Health (Calidad en Salud)
Funded By: US Agency for International Development
Project Duration: 1999-2009

Haiti Voluntary Agencies for Child Survival Project
Funded By: US Agency for International Development
Project Duration: 1989-1995

Jamaica Adolescent Healthy Lifestyles (JA-STYLE)
Funded By: US Agency for International Development/Jamaica
Project Duration: 2005-2010

Kazakhstan TB Project
Funded By: Project HOPE
Project Duration: 2000-2001

Malawi Support to AIDS and Family Health Project
Funded By: US Agency for International Development
Project Duration: 1994-1998

Project for Regional Management of Health Services
Funded By: US Agency for International Development/Morocco
Project Duration: 1994-2003

Morocco Family Planning and Maternal Child Health
Funded By: US Agency for International Development
Project Duration: 1994-1999

Regional Management of Health Services Project (Project de Gestion Régionale des Services de Santé, PROGRESS)
Funded By: US Agency for International Development
Project Duration: 2000-2003

Mozambique Primary Health Care Support Project
Funded By: US Agency for International Development
Project Duration: 1994-1999

Improving Medical Injection Safety in Namibia Project
Funded By: President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development
Project Duration: 2004-2009

Rapid Expansion of Nutritional Recuperation Services for Malnourished Children in Nigerien Facilities
Funded By: American Jewish World Services, US Agency for International Development Office of Foreign Disaster Assistance, and UNICEF
Project Duration: 2005-2007

Niger Family Health and Demography Project
Funded By: US Agency for International Development/Niger
Project Duration: 1989-1995

Peru Strengthening Health Institutions Project, MaxSalud Component
Funded By: US Agency for International Development/Peru
Project Duration: 1994-1999

Peru Consultancy in Quality Assurance and Improvement: Health and Basic Nutrition Project
Funded By: The World Bank
Project Duration: 1999-2000

Quality Assurance Project (QAP) I, II, and III
Funded By: US Agency for International Development
Project Duration: 1990-2008

Romania Health Care Reform Program
Funded By: US Agency for International Development /Romania
Project Duration: 2005-2008

PreventAIDS
Funded By: US Agency for International Development
Project Duration: 2005-2008

Women and Infant Health Strategy
Funded By: US Agency for International Development
Project Duration: 1999-2003

TASC II Tuberculosis/South Africa
Funded By: US Agency for International Development/South Africa
Project Duration: 2004-2009

Integrated Technical Assistance Project
Funded By: US Agency for International Development/South Africa
Project Duration: 2004-2008

Strategic and Policy Assistance to the Agency for Accreditation and Quality Assurance of the Republic of Srpska
Funded By: The World Bank
Project Duration: 2000-2001

Rural Community Health Project
Funded By: US Agency for International Development/Tunisia
Project Duration: 1981-1985

Education Programs of the National Heart, Lung and Blood Institute and the National Heart, Lung and Blood Institute Campaign
Funded By: US National Institutes of Health, National Heart, Lung, and Blood Institute
Project Duration: 1987–1993 and 1997–2002

Energy Information Administration Training
Funded By: US Department of Energy
Project Duration: 1995-1996

Evaluation of Family Planning Programs
Funded By: US Department of Health and Human Services
Project Duration: 1980-1985

Separation and Control Hiring Assessment
Funded By: US Federal Aviation Administration
Project Duration: 1991-1996

Instructional Services for the Federal Aviation Administration Center for Management Development
Funded By: US Department of Transportation, Federal Aviation Administration
Project Duration: 1987-1992

Federal Information and Communication Services
Funded By: US National Institutes of Health
Project Duration: 2001-2006

Goddard Space Flight Center: Human Resources and Organization Development Project
Funded By: US National Aeronautics and Space Administration
Project Duration: 1987-1992

Haitian American Training Institute
Funded By: US Department of Education
Project Duration: 1981-1982

Maryland Department of Transportation Human Resources Services
Funded By: State of Maryland Department of Transportation
Project Duration: 1994-1997

National Drug Abuse Center for Training and Resource Development
Funded By: US National Institute for Alcohol Abuse and Alcoholism
Project Duration: 1979-1982

UNICEF Malawi and New York
Funded By: UNICEF
Project Duration: 2008-2010

Quality Assurance Evaluation of the Peace Corps Medical Support System
Funded By: The US Peace Corps Office of Medical Service
Project Duration: 1991-1995

Reorganization of the District of Columbia Department of Health
Funded By: US Office of Personnel Management
Project Duration: 1995-1997

National Research Utilization Project
Funded By: US Department of Justice, National Institute of Justice
Project Duration: 1976-1985

Rural Transit Assistance Program Training
Funded By: US Department of Transportation
Project Duration: 1989-1993

Improvement of Maternal and Neonatal Health in Belize
Funded By: Ministry of Health, Belize, Central America
Project Duration: 2009 to 2010

e-Health in Bangladesh: Survey on Strengthening Remote Health Service Facilities
Funded By: Grameen Communication Center
Project Duration: 2008

Technical Assistance and Support Contract 2 (TASC2): Global Health
Funded By: United States Agency for International Development
Project Duration: 2004–2009

Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey, Phase II (HAI)
Funded By: US Centers for Disease Control and Prevention (CDC)
Project Duration: 2010-2011

Strengthening Community Safety Nets (SCSN)
Funded By: United States Agency for International Development
Project Duration: 2008-2011

Food and Technical Assistance (FANTA) II
Funded By: United States Agency for International Development
Project Duration: 2010 to 2011

Technical Assistance and Support Contract (TASC2) Tuberculosis
Funded By: United States Agency for International Development (USAID)
Project Duration: 2004–2009

Quality Improvement of Family Planning Care
Funded By: Belize Ministry of Health
Project Duration: 2011 to 2012