Human-centered design approaches to improving quality of care

We’ve been thinking a lot about human-centered design at JSI, particularly through our role as the Global Research Partner on the Innovations for Maternal, Newborn, and Child Health Initiative. Human-centered design isn’t “new” in and of itself; the approach borrows heavily from participatory research, ethnography, and other disciplines, and provides a structured approach to thinking through how users of a product, service, or system feel and designing with their needs in mind, which we’ve found fascinating to explore for its potential in public health and behavior change projects.

I recently stumbled upon an interesting example of a 1995 curriculum for improving quality of care  that leverages a number of creative, design-y techniques (e.g. role playing, journey mapping, and storytelling) from before “design” got trendy in the development space.  The curriculum is well worth reviewing to see a creative take on how to train health workers to provide better quality care to clients through activities that help them better understand the needs and feelings of their clients.

The curriculum is designed in six modules that take place over several weeks. The modules and their respective objectives include:

  1. Why I am a health worker: To examine the reasons why people become health workers, and how these reasons influence their relationship with women clients,

  2. How do our clients see us?: To investigate health workers’ ideas about how their clients see them, and how this influences their relationship with women clients,

  3. Women’s status in society: To explore health workers’ understanding of the most important factors that influence the degree of control that women have over their day-to-day lives and the decisions that they make about themselves, their families and their homes,

  4. Unmet needs: To explore needs women have related to health that are often ignored, and to identify possible solutions,

  5. Overcoming obstacles at work: To find out what problems health workers have at workand how these problems affect relationships with women clients,

  6. Solutions: To draw together what has been learned at the previous sessions and conclude by developing an action plan on what can be done to improve quality of care.

There was a recent evaluation of the quality of care curriculum’s use in Zambia, Senegal, Mozambique, and Uganda that sparked some discussion. Kathleen McDonald wrote a great summary post over on the Maternal Health Task Force blog about the curriculum and the evaluation findings.

A question that has often come up in our discussions around design thinking and public health is: “how is it different” from what we already do? The missing link between the workshops proposed in this curriculum and an empathy-driven human-centered design approach seems to be that the workshops are facilitated for the health workers, who share their thoughts on how they are perceived and the quality of care provided, but doesn’t bring in clients to share their actual experiences of receiving care as a means of creating empathy with the end user (recipient of services).

The evaluation findings demonstrate the power of this kind of immersive, engaging approach to tackling the challenge of improving quality of care, but I would be interested in seeing if there’s greater impact if the end users of services are engaged as participants as well, allowing health workers to hear from the women about their unmet needs and feelings about the quality of care, rather than hypothesizing based on their experiences. While one could argue that the health workers are also recipients of health care at some point in their lives, I would expect it is a different experience for them than for a woman coming from a rural village for services.

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