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.

HAI-LIGHTS

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

PMTCT – HIV/AIDS

HYPERTENSION

MENTAL HEALTH

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Funding

[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.

[2017-2022] Scaling up the Systems Analysis and Improvement Approach for pMTCT in Mozambique.

This project receives funding support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH113435, via a subagreement from the University of Washington.

[2016-2019] Usability and Feasibility of a Phone-based Decision Support Tool for Option B+.

This project received funding support from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number R21AI124399, via a subagreement from the University of Washington.

[2014-2017] Assessing a tablet-based clinical training approach for nurses providing Option B+ services.

This project received funding support from the National Institute of Allergy and Infectious Disease of the National Institutes of Health under award number P30AI027757, via a subagreement from the University of Washington.

[2014-2015] Cost and Effectivenss of Systems Analysis & Improvement for pMTCT in Mozambique.

This project received funding support from the National Institute of Child Health and Human Development of the National Institutes of Health as a supplement to award number R01HD075057, via a subagreement from the University of Washington.

[2017-2020] Systems analysis and improvement approach to optimize task-shifted mental health diagnosis and treatment cascades (SAIA-MH).

This project receives funding support from the National Institute of Mental Health of the National Institutes of Health under award number R21MH113691, via a subagreement from the University of Washington.

[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.

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