Jacaranda is a global innovation laboratory. We are continually creating, adapting and integrating the best clinical protocols, efficiency processes, health technologies, and human resource strategies to build a cost-effective model for the best quality maternal health care.
In order to reduce maternal mortality on a global scale, the world needs better models for training, incentives, and maintaining quality in the nursing workforce. At Jacaranda, our goal is test and disseminate practical facility-based approaches to create a new generation of nursing leaders who are strong, patient-centered managers..
We recognize that traditional nursing education in Kenya leaves something to be desired. We are deeply invested in enhancing our nurses’ skills and performance as well as setting a new standard for nursing care.
We actively track individual performance and knowledge gaps through our medical records and on-the-job assessments. We are training our nurses to be strong leaders and managers, from handling obstetric emergencies to running clinical case reviews and quality initiatives.We are developing creative non-financial incentives for hiring and retention, and creating a clear career ladder to keep nurses moving up and growing their capacity. We recognize that medical knowledge is evolving, and that continuing education is a critical part of a strong workforce. We are working with expert clinical educators and faculty to design dynamic continuing medical training for our nurses that includes hard and soft skills.
We recognize how overworked nurses are around the world, and how difficult it is to provide high quality care when spread thin. We focus on task shifting and task sharing to help ensure that clinical expertise falls in the right hands and that human resources are allocated optimally. Our goal is for our nurses to provide all clinical care, while patient care assistants (nurse aides) provide non-clinical care and community health workers (CHWs) manage home visits and client education.
Mobile Phone Technology
We leverage the fact that three out of four Kenyans have mobile phones which many use for much more than traditional communication. At the maternity hospital, we use a mobile phone system to input client data and track health trends. When clients go home, we send them customized health tips and scheduling reminders through SMS. We distribute patient satisfaction surveys through mobile phones that give us valuable information about how we can improve the care we provide. Finally, we encourage dynamic communication with our clients through a 24-hour Jacaranda customer care hotline that is available to answer health and logistical questions.
Electronic Medical Records
We are in the process of developing the heart and soul of our technology engagement: An electronic medical record system. The EMRS will guide clinicians through challenging decision-making by automatically identifying risk factors. On the back end, it will enable us to report on clinical data, track patterns, and flag patient records during emergency. We are using open source technology and local developers to build a culturally appropriate system for our context, rather than developing an expensive, custom system.
We know that financial accessibility is a major barrier to high-quality healthcare in Kenya, so we have developed an internal solution. MamaKiba (meaning “MotherSavings”) is a unique mobile pre-payment service. This service allows our clients to safely prepay towards delivery costs, which both encourages a culture of saving and reduces the financial burden of delivery.
Our goal is to bring the approaches and tools used by the most innovative health networks in the US, such as Kaiser Permanente and Mayo Clinic, into low-resource settings. We create the Jacaranda patient experience for women and with women: Our first maternity hospital was designed with input from clients and experienced nurses, and our mobile phone based savings platform was borne from feedback that we received in focus groups.
We are inculcating a culture of respectful maternity care at our hospitals. Our clinical safety guidelines are tailored to the resources and cultural background of our clients, and our staff receives intensive customer service training. We do home visits for some clients, and are exploring new ways to improve education and birth planning, such as group antenatal care education and mobile phone health messaging.
We recognize the importance of men when considering the decisions around maternal health. These decisions include: location of delivery, maternal health savings plans, education around maternal health and prenatal warning signs, and postpartum family planning. We involve fathers through male-oriented marketing materials, inclusive antenatal care visits, and unique education and counseling for men.
We are creating tools for better day-to-day clinical quality as we embed a culture of quality into our operations. Ultimately, our goal is to have a set of practical and tested tools that healthcare providers in all low-resource settings can use to deliver high quality, low cost, patient-centered maternity care. Our “Quality Toolkit” incorporates:
- Evidence-based protocols and tools such as checklists and evidence-based algorithms to make care more systematic;
- Regular clinical case and chart reviews with staff to discuss challenges, lessons, and insights;
- Measuring impact through a mobile phone database and electronic medical records, which, through the collection of client information, allows us to identify trends in performance.
- Building decision support tools into electronic health record systems to help nurses manage care in emergencies and increase adherence to obstetric protocols.