Origins | Theory and Principles | Methodology | QA/QI | QI vs. PI | Summary
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Thada Bornstein, MEd, Deputy Training Director, 
Quality Assurance Project

Performance Improvement (PI) is a methodology for improving the quality of institutional and individual performance. PI, a term often used interchangeably with Human Performance Technology (HPT), has attracted much attention lately in the international development community, due largely to the enthusiasm of the USAID Office of Population, which is encouraging Cooperating Agencies (CAs) to adopt PI. The CAs are at varying stages of familiarity with both PI and quality improvement (QI). Because even seasoned practitioners have different perspectives on the relationship between PI and QI, the topic has caused lively and useful discussions in the CA community.

This article describes some of the similarities and differences between the two methodologies. It is written and should be read with the understanding that QI and PI are continually evolving and that there is no discrete boundary between them.

In both QI and PI, their application in the U.S. and other developed countries is at a later stage of evolution and experience than in developing countries. This paper is limited to the application of QA/QI and PI in international healthcare. (Many of the statements in this article apply equally to QA and QI.)

The USAID-sponsored Performance Improvement Consultative Group (PICG) is composed of CA representatives who have worked with the Office of Population to develop performance improvement strategies, tools, and approaches. The PICG has developed its own framework based on that of the International

Society of Performance Improvement (ISPI). The customized version is suited to the needs and experiences of those who work in the developing world. This version emphasizes the step of obtaining stakeholder agreement to the PI process from the very beginning, before any intervention is attempted—thus avoiding the problems that can arise when there are multiple clients with different goals. PICG has agreed to use the common framework in the field in order to reduce confusion among clients, although each group will apply the PI process somewhat differently.

Go to Performance Improvement

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¹ In general, the Performance Improvement framework is an evolving concept with new concepts emerging as work continues in this field. The concepts presented here reflect the current thinking when this article was prepared.

This article appeared in the Spring 2001 issue of the Quality Assurance Project's QA Brief. This newsletter, including the articles referenced in this document and other articles on quality improvement, can be accessed at http://www.qaproject.org in the products section.

Quality Assurance Project is operated by the Center for Human Services in collaboration with the Joint Commission Resources (formerly known as the Joint Commission International) and Johns Hopkins University (including the School of Hygiene and Public Health, The Center for Communication Programs, and the Johns Hopkins Program for International Education in Reproductive Health). The project is sponsored by the United States Agency for International Development under Contract Number HRN-C-00-96-90013. For additional information please contact: Dr. David Nicholas, Director Quality Assurance Project Center for Human Services 7200 Wisconsin Avenue, Suite 600 Bethesda, MD 20814-4811 dnicholas@urc-chs.com or Dr. James Heiby, Project Manager G/PHN/HN/HPR U.S. Agency for International Development Washington, DC 20523-1817 jheiby@usaid.gov

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