Patient-centered design: Maternity care designed by women, for women

Imagine waiting for six hours for antenatal visit, only to be seen by a nurse who doesn’t have time to answer questions about your pregnancy, or doesn’t bother to treat you with respect. A recent Kenyan government survey indicated that bad patient experience is one of the major reasons that women in Kenya avoid giving birth in hospitals and other birth facilities. The vast majority of women who participated in Jacaranda’s field research in Nairobi complained of long waits, poor treatment from nurses, crowded labor wards, and difficulty getting education and birth-preparedness counseling.

If you have any doubts about the pervasiveness or the detrimental effects of this problem, read the eye-opening “Failure to Deliver: Violations of Women’s Human Rights in Kenyan Health Facilities,”  by the Kenya Federation of Women’s lawyers, or USAID’s powerful “Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis.”

This issue of poor service is one of the biggest hurdles to increasing delivery in facilities. Jacaranda aims to change that dynamic by providing care that is respectful and responsive to the needs of mothers. One of the most interesting ways we’re meeting this goal is by following the lead of organizations like the design consultancy IDEO and the Mayo Clinic, who advocate for a principle known as “patient-centered design.”

Patients draw their ideal waiting room

Patients draw their ideal waiting room

Patient-centered design reflects the notion that healthcare can be more responsive and respectful if providers engage patients in the design process. It sounds straightforward, but patient-centered design is far from the norm; this really is a new frontier in healthcare. Some of the best hospitals in the States are starting to do it; both Kaiser Permanente and the Mayo Clinic have crack teams of designers who work with clinicians and patients to design friendlier, more effective care. A greater focus on the patient results in improvements like physical spaces that encourage recovery, scripts and settings for better doctor-patient interaction, and better ways to exchange information during nurse shift changes. For an example see:

Here in Kenya, Jacaranda Health has approached patient-centered design in a similar way.  Over the last year and a half, we have held design sessions with groups of prospective patients and nurses to get their help in developing our model of care. In these sessions, we borrow from the playbook of design firms like IDEO, using tools like brainstorming, role-playing and sketching to develop basic prototypes of potential tools and solutions.

The result is not only deeper knowledge of our patients and insights about the most effective ways to provide care, but a patient experience designed by patients for patients.  Our patient-centered design process has led to a number of additions to our standard services, including:

  • Greeters to guide patients through the delivery process;
  • A performance-review process that evaluates our nurses not only on clinical quality, but also on patient satisfaction and respect;
  • Group birth-preparedness education and Q+A sessions, led by community health workers in our waiting rooms; and
  • Strategies to better accommodate fathers during antenatal-care visits.
Clients give feedback on audio presentations for birth preparedness

Clients give feedback on audio presentations for birth preparedness

As is the case with everything we do, our patient-design process is intentionally a work in progress. Each phase of Jacaranda’s growth will offer us more opportunities to seek ideas from our patients and learn how we can serve them better. Involving our patients in designing their own care gives Jacaranda a competitive advantage over other facilities. But just as importantly, it lets the women of Nairobi design the maternity care they want, so that more of them will seek skilled care, resulting in healthier outcomes for mothers and babies.




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