Improving quality of care at time of birth - M4ID
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SERVICE DESIGN BREAKFAST
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Transcript of Improving quality of care at time of birth - M4ID
SERVICE DESIGNBREAKFAST
INNOVATIVESERVICE DESIGN
AND COMMUNICATION FOR DEVELOPMENT
AND HEALTH
A SMALL TEAMWITH BIG AMBITIONS
98%
LONG WAY TO GO
WHO
M4ID
MAKAREREUNIVERSITY
UGANDA
UNIVERSITYOF IBADAN
NIGERIA UNIVERSITYOF SAO PAULO
BRAZIL
LOCALINNOVATION
PARTNERS
THE BILL AND MELINDA GATESFOUNDATIONS
CHANGE THE HISTORY OF OBSTETRIC CARE
A tool that will help health workers to better monitor women
and make decisions about next steps of their care
during childbirth
New tools for women, their families and their communities to support and educate them
during pregnancy and childbirth
SELMASimplified effective labour monitoring to action tool
PSPPassport to Safer Birth
A 50 YEAR OLD TOOL?
CUSTOMER EXPERIENCE?
HOW WE DO IT?
OBSERVE PEOPLE , THEIR RELATIONSHIPS AND
ACTIONS
TALK WITH WOMEN, FAMILY MEMBERS AND
HOSPITAL STAFF ABOUT THEIR PERCEPTIONS
TO IDENTIFY IDEAS AND SOLUTIONS TO IMPROVE
THE QUALITY OF CARE
THEN DESIGN & BUILD TOOLS
TOGETHER
AND TRY THEM OUTIN PRACTICE
COLLECT FEEDBACK AND IMPROVE THEM
DISCOVER & DEFINE
DESIGN & BUILD
Gathering of data:
/ In-depth interviews/ Direct observation/ Shadowing/ Design workshops
Developing prototypes together with target users:
/ In-depth interviews/ Workshops/ Field testing kit
Design of solutions: From rapid prototypes to minimum feasible level prototypes that can
Remote
On-location
Uganda initial visit
Preparationsand desk study
Analysis Analysis
Ugandadesign
research
Nigeriadesign
research
Uganda co-design
Nigeriaco-design
Solutions/research strategy
Iterative process
Research preparation
SynthesisInput Formative
Design
AND WHERE?
COMMUNITY
FACILITY
COMMUNITY
FACILITYrural / low volume urban / high volume
LOOK AT THE EXTREMES
DOCTORS, WOMEN, NURSES, MIDWIVES
MOTHERS
TRADITIONAL BIRTHATTENDANTS &
COMMUNITY HEALTH VOLUNTEERS MEN, FATHERS & FATHERS TO BE
MOTHERS IN LAW, EXTENDED FAMILY
PERCEPTIONS, EXPERIENCESDURING PREGNANCY & BIRTH
KNOWLEDGE AND INFORMATIONSEEKING BEHAVIOR
INTERACTIONS BETWEENSTAFF AND CLIENTSCLINICAL PRACTICES AND ROUTINES
MYTHS AND RELIGIOUSBELIEVES
BARRIERS AND OBSTACLES DECISION MAKING
DESK STUDY
80 papers
15 interviews
50 projects &
innovations
10books
Pregancy, labour and risk signs Referral
process
Transport
Maternity waiting home
Admission/Reception
Waiting room/hall
Delivery room
Recovery room/Overnight stays
Payment/Discharge
PRE-PREGNANCY PREGNANCYWoman’s journey
Key touchpoints
Journey moments
Access to blood/drugs
Return
Post-partumcheck ups
Stories
Education
Family planning
Myths and believes
Stakeholdersand Involvement
Women’s experience and feelings
Identified issues and bottlenecks
Questions to be researched
Opportunities identified/ Value creation
Antenatal check ups
Cultural norms
Superstitious believes & mythsFears in generalAttitudes to and awareness towards pregnancyRole and access to technology and mediaRole and communication habits with the stakeholdersFamily planningFirst touch point pregnancy health careGeneral health-seeking behaviour andhabitsLevel of education & literacyPrevious birth experiencesWOM of birth storiesPerception of facility based care vs. home delivery
ATTENDING ANTENATAL CAREReasons for late attendenceReasons not to attenedProcesses, routines and recommendedprotocolsTouchpoints and rolesAccessibilityInformationExperience & quality of careRole of the other stakeholders, likehusbands, mothers-in-law...
IDENTIFYING LABOUR & RISK SIGNSFirst touchpointBody knowledgeTraditional habits & belifsReasons for delaying the transportationInformation about access to helpBias in risk detection
REFERRAL PROCESSProcess, routines and rolesMotivations, cultural bias
TRANSPORTTransport options & costsReasons for delayCommunity insurances & schemesCommunication between the transportand health facilityExperienceArrangement of the home-responsibili-tiesLiabilities
Identi�cation of the possibilitiesSocial acceptanceDIY optionsRoles, protocols and touchpoints
Forms of neglect, disrespect and abuseRoles, processes and protocols (visibleand background)Delivery statisticsStructural statisticsSupply chain managementLeadership and managerial practices(feedback, rewarding, motivation)Training & educationPriorization & screeningWorking conditions, safetyHygiene standards and habitsAccountabilityDi�erent spaces (Layout of the facility)Laws and regulations vs. innovationpotentialCommunication and recording methodsLevel medical equipmentsKPI's for the hospital & sta�
Map / journey within the hospitalHome vs. facility experienceEmotional needs and fearsPrivacy & embarrassmentAccess to information about process andstatusCompanions and family membersKnowledge about the patient rightsCosts of hospital stayPayment methods.Access to food & waterHygiene habitsAccess to farmacyPeers & other patientsAccess to communicationOptions for decision-making
Postnatal care (PNC) / check-upsFollow-up instructions (breastfeeding etc.)Family planningTake-away packagesPost-facility storiesReception of the new mother/babyReactions to costs
DELIVERY POST-PARTUM
Mother
Husband
Mother in law
Health worker
Friends
IN THE FIELD
“This makes my mind think big”
“This makes me focus on one thing”
“If we need help we just shout and hope someone comes. Having a tool to call for help would really be useful“
“No one has a full overview on what is going on. We just see the bits and pieces and therefore sometimes its challenging to prioritize right“
MIDWIFE PROFILES
THE RESCUER
THE IMPROVERTHE SURVIVOR
THE FOLLOWER
Less skillsLack of support
UncertaintyClinical process
ExperienceIntuitionAuthorityEmpathy
Con
text
of
wor
k
Way of working
Sharing work in teamsComplications are taken care in the facility
Often working aloneComplications lead to referrals
FOCUSAREAS
THE RESCUER
THE IMPROVERTHE SURVIVOR
THE FOLLOWER
Less skillsLack of support
UncertaintyClinical process
ExperienceIntuitionAuthorityEmpathy
Con
text
of
wor
k
Way of working
Sharing work in teamsComplications are taken care in the facility
Often working aloneComplications lead to referrals
TIME & TASK MANAGEMENT
VALIDATION &DOCUMENTATION
DATA &RECOMMENDATION
KNOWLEDGE &DECISION MAKING
Workstation Delivery room
Labour room Manager’s Office
TOUCHPOINT OVERVIEW
”There is no-one to ask so I just need to manage.”
The Survivor
MONITORING LABOUR
“Service Design sounds like a wonder-ful approach. Rarely have I been asked what would really help me. Contribut-ing to designing the solutions I will use makes me feel empowered and valued.”
DESIGNINGHEALTHY SYSTEMS
IN AHEALTHY
WAY
DESIGN THINKING
SERVICE DESIGN
