The Systems Analysis & Improvement Approach:

Applying Systems Engineering to Optimize Complex Care Cascades

The Systems Analysis and Improvement Approach (SAIA) is a multi-step, evidence-based implementation strategy used by manager/health provider teams to systematically identify and address bottlenecks in their own health care delivery systems and prioritize solutions.  

 SAIA brings together tools from systems engineering with continuous quality improvement to optimize patient flow and make health service delivery more effective and efficient.  SAIA is adaptable to local context, supporting frontline facility staff to gain a comprehensive view of their complex delivery system, identify and prioritize areas to improve, and test modifications aimed at improving service delivery. The process is iterative, which means health care teams can continue to use the package to further improve care and respond to new bottlenecks that arise.

The core elements of SAIA are:

  1. Cascade Analysis Tool – allows teams to visualize and quantify patient drop out along key steps in a care continuum, and highlight targeted areas for improvement that will optimize care delivery;
  2. Process Mapping – helps teams map patient and workflow processes and facilitates the identification of small system “tweaks”, or workflow modifications, to reduce inefficiencies and improve service delivery;
  3. Continuous Quality Improvement Cycles – during which health provider teams test workflow modifications and measure their effectiveness.

SAIA was designed by HAI faculty at the University of Washington and first implemented by Health Alliance International and the Network of AIDS Researchers in East and Southern Africa (NARESA) to improve the prevention of mother-to-child HIV transmission service delivery.

SAIA has proven scalable within public-sector health systems and has since been adapted for use in multiple service areas—including hypertension, mental health, substance abuse, pediatric HIV testing & care, HIV testing in family planning, and cervical cancer screening and treatment—and locations—including Mozambique, Côte d’Ivoire, Kenya, and the US.


Check out how  public sector health providers are using SAIA to problem-solve service delivery gaps and barriers in real time




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[2019-2024] Systems Analysis and Improvement to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN).

This project receives funding support from the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R01HL142412, via a subagreement from the University of Washington.

[2012-2015] Systems Analysis and Improvement to Optimize pMTCT: A Cluster Randomized Trial.

This project received funding support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under award number R01HD075057, via a subagreement from the University of Washington.


For additional SAIA project funding information, visit the SAIA main page.


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