Improving quality of care at time of birth - M4ID
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Improving quality of care at time of birth: The Better Outcomes in Labour Difficulty (BOLD) Project The BOLD project is the first project under WHO to address maternal mortality and morbidity in underserved regions through a service design approach. M4ID is designing a set of solutions to improve the demand and provision of quality of care at the time of birth using community and facility based research and co-design with women and healthcare staff in Uganda and Nigeria. These solutions aim to redefine labour monitoring, empower midwives in their roles and save lives of mothers and babies in underserved regions. Presenter: Melanie Wendland
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Improving quality of care at time of birth - M4ID
- 2. INNOVATIVE SERVICE DESIGN AND COMMUNICATION FOR DEVELOPMENT AND HEALTH
- 3. A SMALL TEAM WITH BIG AMBITIONS
- 4. 98%
- 7. WHO M4ID MAKARERE UNIVERSITY UGANDA UNIVERSITY OF IBADAN NIGERIA UNIVERSITY OF SAO PAULO BRAZIL LOCAL INNOVATION PARTNERS THE BILL AND MELINDA GATES FOUNDATIONS
- 8. CHANGE THE HISTORY OF OBSTETRIC CARE
- 9. 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 SELMA Simplified effective labour monitoring to action tool PSP Passport to Safer Birth
- 10. A 50 YEAR OLD TOOL?
- 13. 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 OUT IN PRACTICE COLLECT FEEDBACK AND IMPROVE THEM DISCOVER & DEFINE DESIGN & BUILD
- 14. 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 Preparations and desk study Analysis Analysis Uganda design research Nigeria design research Uganda co-design Nigeria co-design Solutions/ research strategy Iterative process Research preparation Synthesis Input Formative Design AND WHERE?
- 15. COMMUNITY FACILITY COMMUNITY FACILITY rural / low volume urban / high volume LOOK AT THE EXTREMES
- 16. DOCTORS, WOMEN, NURSES, MIDWIVES MOTHERS TRADITIONAL BIRTH ATTENDANTS & COMMUNITY HEALTH VOLUNTEERS MEN, FATHERS & FATHERS TO BE MOTHERS IN LAW, EXTENDED FAMILY
- 17. PERCEPTIONS, EXPERIENCES DURING PREGNANCY & BIRTH KNOWLEDGE AND INFORMATION SEEKING BEHAVIOR INTERACTIONS BETWEEN STAFF AND CLIENTS CLINICAL PRACTICES AND ROUTINES MYTHS AND RELIGIOUS BELIEVES BARRIERS AND OBSTACLES DECISION MAKING
- 19. 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 PREGNANCY Woman’s journey Key touchpoints Journey moments Access to blood/drugs Return Post-partum check ups Stories Education Family planning Myths and believes Stakeholders and 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 & myths Fears in general Attitudes to and awareness towards pregnancy Role and access to technology and media Role and communication habits with the stakeholders Family planning First touch point pregnancy health care General health-seeking behaviour andhabits Level of education & literacy Previous birth experiences WOM of birth stories Perception of facility based care vs. home delivery ATTENDING ANTENATAL CARE Reasons for late attendence Reasons not to attened Processes, routines and recommended protocols Touchpoints and roles Accessibility Information Experience & quality of care Role of the other stakeholders, like husbands, mothers-in-law... IDENTIFYING LABOUR & RISK SIGNS First touchpoint Body knowledge Traditional habits & belifs Reasons for delaying the transportation Information about access to help Bias in risk detection REFERRAL PROCESS Process, routines and roles Motivations, cultural bias TRANSPORT Transport options & costs Reasons for delay Community insurances & schemes Communication between the transport and health facility Experience Arrangement of the home-responsibili- ties Liabilities Identification of the possibilities Social acceptance DIY options Roles, protocols and touchpoints Forms of neglect, disrespect and abuse Roles, processes and protocols (visible and background) Delivery statistics Structural statistics Supply chain management Leadership and managerial practices (feedback, rewarding, motivation) Training & education Priorization & screening Working conditions, safety Hygiene standards and habits Accountability Different spaces (Layout of the facility) Laws and regulations vs. innovation potential Communication and recording methods Level medical equipments KPI's for the hospital & staff Map / journey within the hospital Home vs. facility experience Emotional needs and fears Privacy & embarrassment Access to information about process and status Companions and family members Knowledge about the patient rights Costs of hospital stay Payment methods. Access to food & water Hygiene habits Access to farmacy Peers & other patients Access to communication Options for decision-making Postnatal care (PNC) / check-ups Follow-up instructions (breastfeeding etc.) Family planning Take-away packages Post-facility stories Reception of the new mother/baby Reactions to costs DELIVERY POST-PARTUM Mother Husband Mother in law Health worker Friends
- 20. IN THE FIELD
- 32. “This makes my mind think big” “This makes me focus on one thing”
- 33. “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“
- 34. MIDWIFE PROFILES THE RESCUER THE IMPROVERTHE SURVIVOR THE FOLLOWER Less skills Lack of support Uncertainty Clinical process Experience Intuition Authority Empathy Contextofwork Way of working Sharing work in teams Complications are taken care in the facility Often working alone Complications lead to referrals
- 35. FOCUS AREAS THE RESCUER THE IMPROVERTHE SURVIVOR THE FOLLOWER Less skills Lack of support Uncertainty Clinical process Experience Intuition Authority Empathy Contextofwork Way of working Sharing work in teams Complications are taken care in the facility Often working alone Complications lead to referrals TIME & TASK MANAGEMENT VALIDATION & DOCUMENTATION DATA & RECOMMENDATION KNOWLEDGE & DECISION MAKING
- 36. Workstation Delivery room Labour room Manager’s Office TOUCHPOINT OVERVIEW
- 37. ”There is no-one to ask so I just need to manage.” The Survivor MONITORING LABOUR
- 38. “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.”