This participant manual for the skill-building workshop delivered by staff of the USAID Health Care Improvement Project at the May 2009 Global Health Council annual conference was developed to guide workshop participants in designing their own improvement project applying the principles of modern health care improvement to the participant’s area of choice.  The manual guides the participant through eight steps in conceptualizing and designing an improvement project.  Using a fictional scenario for a health facility team that is trying to reduce post-partum hemorrhage through the introduction of active management of the third stage of labor, the manual provides examples of how the fictional team addressed each step in the process of designing their health care improvement activity.