roberta tassi / using a human-centered design process to drive healthcare innovation: the unicef...

Using a human-centered design process to drive healthcare innovation: THE UNICEF BACKPACK PLUS PROJECT

Roberta Tassi, Senior Design Researcher, frog

BIOCAT HOW DESIGN THINKING CAN IMPROVE MY BUSINESS? 23/01/2014 2

frog | Introduction

FROG IS A GLOBALPRODUCT STRATEGY AND DESIGN FIRMWe bring together a unique combination of creativity, collaboration and business planning to deliver breakthrough products and services to the market. We are more than 600 strategists, researchers, designers, and technologists who consult and partner with clients across industries and geographies. We help organizations increase their value and expand their o!erings through a human-centered design process.


frog | Introduction


frog Milan | Introduction

SEATTLE

SAN FRANCISCO

AUSTIN

NEW YORK

BOSTON

MUNICHAMSTERDAM

SHANGHAI

frog MILAN


frog | Introduction

WE APPLY A HUMAN-CENTERED DESIGN PROCESS TO DRIVE HEALTHCARE INNOVATIONDesign Research, Design Frameworks, Design Principles

CENTERED ON USERS


Our Approach | Design Research

WE USE DESIGN RESEARCH TO ILLUMINATE HUMAN PROBLEMS -BOTH KNOWN AND UNKNOWN- BY COLLECTING INSIGHTS THROUGH OBSERVING AND UNDERSTANDING USER BEHAVIORS.

DRIVEN BY CREATIVITY

DESIGNED TO BE INCLUSIVE

UNDERSTANDING HUMANS

Observing action

Understanding behavior

Building empathy

Immerse in the context

Finding underlying motivations

What people say, do, think.

360

HCP-PWD COLLABORATION

REAL TIME SELF-MANGEMENT- The daily rituals of self-management are the core: essential both for outcomes and to generate the data upon which the 360 system rests

- All feedback loops ultimately aim to influence outcomes by influencing this sphere

- Non-insulin-using patients lack a real-time 'closed loop' and therefore can lack intrinsic motivation to engage

- MDI patients miss the automatic data collection of pump users, although the potential richness and value of data is equivalent.

- Many key parameters remain untracked: diet, exercise, mood, stress, co-morbidities, etc.

EDUCATION / ADVICE / ENCOURAGEMENT

STANDARD OF CARE

DEVICE CONFIGURATION

THERAPY DECISIONS

360

CAREGIVER

360

CAREGIVER

360

CAREGIVER

360

BG

DAILY LIFE

TREATMENT

DEVICE CONFIGURATION

THERAPY DECISION

MOTIVATION

MONEY

PAYER /PROVIDER

360

HCP

SELFREFLECTIONReviewing progress, goals, and patterns to:- understand relationships between activity, diet, medication, symptoms, and glucose levels;- make choices about therapy and lifestyle.

PWD

SOCIAL MEDIAPHARMACYROCHE

the caregiver often plays an intermediate role between the HCP and the PwD

In essence 360 is a tool for HCP-PwD collaboration in which the PwD provides the data (in their devices) and the HCP interprets the data, makes therapy decisions, and instructs the patient.

POPULATION MANAGEMENTAggregated data over time provides evidence of patient outcomes to help drive best practices and reimbursement.

Utilization and outcomes data can help Roche develop better products and services

Automate consumable reorder?

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Our Approach | Design Frameworks

USER EXPERIENCE MAP

MANAGING COMPLEXITY

Putting the user at the center

Giving tangibility to the intangible

Defining a language to facilitate communication processes

PARTICIPATORY DESIGN SESSION

SYSTEM & VALUE MODEL

WE BUILD DESIGN FRAMEWORKS: ABSTRACT REPRESENTATIONS OF MODELS AND FLOWS THAT TRANSLATE OUR THINKING AND FACILITATE CONVERSATIONS AROUND COMPLEX SOLUTIONS.

Make mesmileWHY

People want network providers and their annoying ads or badly executed software out of the way. R4G wants to make your life feel good, to make you remember that small thing which makes a big di!erence and makes people smile

WHAT

True delight is in the tiny details of the execution, but has a huge impact on the overall experience, especially when it's unexpected.

HOW

Surprise people by giving that one extra touch of love that makes them smile, because they understand you care.

E.g. provide additional functionality and companion content on the phone when the user watches TV.

Nurture ourrelationshipWHY

Most people are indi!erent to telcos and network companies, or are annoyed by having unfit o!ers pushed on them. Putting people first is a core value of R4G, promising to always help out and provide great customer service.

WHAT

A harmonic relationship with a brand is built over time, and based on getting what is best for oneself, while being heard and supported as needed. The more personal/human the relationship is, the stronger it gets.

HOW

Act on what's "best for the user" and actively foster, maintain, and strengthen the personal relationship with them. Make the user feel cared for by o!ering personalized customer service and transparency to all interactions with

E.g. contact users after the first month to ask them if they are satisfied with the service.

E.g. ask movement participants to help create a coverage map that shows how good the network is in di!erent parts of the city.

Make mecountWHY

Today people often feel helpless and at the mercy of companies and institutions. However, there is a new generation in India that wants to leap up and change the future. The R4G movement supports this new mood and generation.

WHAT

A movement has to be about people, and people have to feel like a valuable part of the movement. They have to see that they are participating in creating a better future for themselves and for India.

HOW

Foster a sense of co-creation. This is a network by Indians for India from the ground up. Lower the barriers for entry, make communication tools ubiquitous, and create stronger ties to the online and o"ine community.


Our Approach | Experience Principles

ENVISIONING THE SOLUTION

Identifying the signature moments

Creating principles and user stories

Socializing inside the company/team

FUTURE SCENARIOS

USER STORIES

TOOLS FOR SOCIALIZATION

WE IDENTIFY EXPERIENCE PRINCIPLES TO GUIDE THE DESIGN ACTIVITIES, BRINGING THE DESIRED QUALITIES, BEHAVIORS AND INTERACTIONS TO LIFE THROUGH PRODUCTS AND SERVICES.


Backpack PlusEmpowering Community Health Workers

BIOCAT HOW DESIGN THINKING CAN IMPROVE MY BUSINESS? 23/01/2014

Backpack Plus | Introduction

10

The vast majority of the seven million children who die every year never see a doctor.



11

Community Health Workers are the “last mile” in healthcare and one of the the biggest untapped resources in global health.



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To increase their impact on child mortality, improve e!ectiveness and boost e"ciency, Community Health Workers need holistic solutions that address their daily and long-term needs.

Backpack PLUS o!ers an approach towards a comprehensive and systemic solution to achieve these ambitious goals.


Backpack PLUS | Putting CHWs at the Center

HOW TO DESIGN A COMPREHENSIVE AND SYSTEMIC SOLUTIONTO EMPOWER COMMUNITY HEALTH WORKERS AT A GLOBAL SCALE?1 Design Research | 2 Design Framework | 3 Design Principles


Framework | The Backpack PLUS Model

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We relied on a Human-Centered Design process to shape solutions for CHWs that are based on a deep understanding of their real-world needs.

Understanding CHW Workflow and Needs

RESEARCH


Backpack Plus | Field Research

UGANDABefore CHWs, having medicines to treat malaria available right in the village was a daydream.CHW SUPERVISOR

4 DISTRICTS, 37 INTERVIEWS



SENEGAL3 DISTRICTS, 26 INTERVIEWS

The main challenge is sensitizing people to look for health services to timely treat their illnesses.CHW (ASC)


REAL TIME PROTOTYPING

CARD SORTING

BP+ frogTHINK / KAMPALA, JUNE 4th / 5th

BACKPACK ARCHITECTURE / 02

STORAGE VISIT AT HOME HOUSE-TO-HOUSE VISITS RESUPPLY

CARRYING & LOMG-TERM STORAGEA bag/backpack to store /carry

the register and most supplies

RESUPPLYA chest/container

to hold a minimum amount of supplies (2-3 days)

BP+ frogTHINK / KAMPALA, JUNE 4th / 5th

BACKPACK ARCHITECTURE / 02

STORAGE VISIT AT HOME HOUSE-TO-HOUSE VISITS RESUPPLY

CARRYING & LOMG-TERM STORAGEA bag/backpack to store /carry

the register and most supplies

RESUPPLYA chest/container

to hold a minimum amount of supplies (2-3 days)

CONCEPT EVALUATION & REFINEMENT




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The Backpack PLUS framework is a CHW-centric model that identifies all the essential physical, digital and service-level components required to empower and activate CHWs along their journey.

Mapping and Modeling CHW Programs

FRAMEWORK



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CHWs are crucial links connecting the communities they serve and the health system.

CARE

COMMUNITY HEALTH SYSTEM

SERVICES

TOOLS

CHW

TRUST

CARE

SUPPORT

REPORT

CARE



21

INDIVIDUALCOMMUNITY

ASSESS & TREAT

EDUCATE

RESPECT

TRUST

SUPERVISOR HEALTH CENTER DISTRICT

SUPPLIES

REPORT

COACH

SUPPORT

REPORT

REPORT

INSTRUCT

SUPPLIER

TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDINGRECRUITING UPGRADING

CHW

DIAGNOSTICS TOOLS ENABLERSCOMMODITIES

ASSESS TREAT EDUCATE REPORT



22


ADVANCED MODULES

BASIC SET

DIAGNOSTICSCOMMODITIES TOOLS ENABLERS

ACT AMOXICILLIN

CHLORHEXIDINE

PARACETAMOL

RDT

RESPIRATORY TIMER

MUAC

ORS & ZINC

GLOVES

ALCOHOL PADS ALCOHOL

SCISSORS

SOAP

BANDAGES

SYRINGE

TRASH BIN NOTEBOOKTHERMOMETER

TRANSPORTATION(bike, motorbike,...)

UNIFORM

HOUSE SIGNAGE

ADVANCED ED.MATERIALS

FEEEDBACKSCORECARD

HOUSEHOLDREGISTER

HEALTH PROMOTIONMESSAGES

MISOPROSTOL IPT

JOB AIDS ED. MATERIALS

VISIT REGISTERREFERRAL FORMS

STOCK REGISTER

RAIN BOOTS RAIN COAT

TORCH, LIGHTPENCILS, PENS

SOLAR CHARGER MOBILE PHONE

VITAMIN Amother

VITAMIN Achildren

PILLS CONDOMS PREGNANCY TEST

INJECTABLE

RUTF SCALE

HIV TEST

DEWORMING(Albendazole)

MAMA KIT

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NEW

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BA

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Framework | Inventory of Hard Components

TOOLS

JOB AIDS ED. MATERIALS

VISIT REGISTERREFERRAL FORMS

STOCK REGISTER


Framework | Inventory of Soft Components

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ACTORS INVOLVED

DESIGN PRINCIPLES

SERVICE ELEMENTS

ON DEMAND RESUPPLY (supervisor)

SPECIAL SUPPLY BY INITIATIVES

STOCK-MGMFACILITATORS

Ensure continuity by selecting people who are long-term members of the community (resident, married).

Leverage existing influential roles that are already present in the community.

Manage age limits (min but also max age).

Embrace flexibility to adapt the criteria to specific regions (i.e. nomadic areas, low-literacy,...).

SELECTION CRITERIA

PUBLIC ANNOUNCEMENTS

REGULARREFRESHER

SELECTION TEST

CHWLIST

Define reference recruiting criteria

RECRUITING TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDING UPGRADING

Create modular training plans to enable incremental learning and di!erentiate competences.

Teach fundamentals of time/budget management.

Provide analog and mHealth services that can be access by CHWs also at the end of the training period.

Create a moment at the end of each training session to certify and/or celebrate the new competences aquired by CHWs.

Set up routine refresher training sessions to ensure a continuous learning experience.

Support a continuous learning process

Provide standard protocols with reference materials that guide the assessment through a series of steps.

Create strong consistency and cross-references across job aids, diagnostics, commodities and informational materials.

Include visuals that help understanding and sharing the process also with the patients.

Improve guidance through integrated tools

Provide standard instructions for dosages with supporting reference materials.

Create strong consistency and cross-references across job aids, diagnostics, commodities and information.

Support referral at a system level (i.e. referred patients are given priority at the clinic).

Strenghten follow-up visits through protocols and reminders.

Provide clear instructions & follow-up

Facilitate education processes through rich media (visuals, audio, video).

Optimize content and materials to address di!erent situations (1:1, households, group sessions).

Stimulate an active engagement of the community.

Provide tools to facilitate education

Facilitate consistent data tracking through clear recording standards and protocols.

Enable data sharing across di!erent stakeholders by armonizing tools and optimizing transmission of information.

Enable data mining by facilitating aggregation of information across tools.

Give value to the collected information by giving it back to CHWs and their communities.

Improve data collection and mining

Establish clear roles of a supervisor and relationship to the CHW (e.g. how often they see each other).

Ensure a continuous support and supervision through meetings at defined intervals (e.g. weekly meeting).

Include role-modeling through joint visits with supervisors.

Include spot checks of the supervisor with the community.

Enable the collection of a clear basic set of data that supports the supervisor with performance management.

Enable the supervisor to set real incentives in case of good performance.

Set clear roles and responsabil-ities

Address restocking by using data to make e!ective forecasts.

Maximize resupply e"ciency by communicating availability of stocks.

Bring the supplies as close as possible to CHWs by leveraging existing resources (shops, private supply chains, etc.).

Facilitate transportation (either by reimbursement or by providing logistical support).

Optimize access and system e!ciency

Enhance the community perception of the role of CHWs through branded materials.

Give visibility to the CHW-enabled outcomes inside the community.

Celebrate & reward the work of CHWs

Establish a clear career path based on personal inclinations and impact.

Provide incremental training to enrich and evolve competences.

Establish a clear career path

SUPERVISOR

STANDARDPROTOCOLS

REFERENCE MATERIALS

VISITTRACKING

STOCK TRACKING

HOUSEHOLDTRACKING

COUNSELINGTRACKING

BASIC MODULEON EDUCATION

SPECIAL MODULES(e.g. RDT)

CHW CERTIFICATION

BASIC MODULEON ICCM

FINALTEST

FAMILY/COMMUNITYENGAGEMENT

REFERENCEMATERIALS

MOBILIZATION FOR SPECIAL EVENTS

BEHAVIOR CHANGE DEMONSTRATIONS

STANDARDPROTOCOLS

REFERRAL PROTOCOLS

REFERRAL TRACKING

REFERENCE MATERIALS

ONE-TO-ONE REVIEWS

SPORT PERFORMANCE CHECK

GROUPREVIEWS

‘LEAVE-BEHIND’INSTRUCTIONS

REMINDER SYSTEM

PATIENTTRACKING

EDUCATIONALGAMES

COMMUNITY REWARDING PLANS

HEALTH CAMPAIGNS

HOUSEHOLD GOALSRECOGNITION

RESUPPLY BY CONSUMPTION

ADDITIONAL TRAINING MODULES

GRATIFICATION BY BRANDED KIT

REIMBURSEMENTS(e.g. TRANPORT)

INCENTIVES THROUGH GADGETS

FACILITATION BYBASIC ENABLERS

CELEBRATION OF SUCCESS

PERFORMANCE BOARD

SUPERVISIONGRID

ABILITYCHECK

CARRIERPATH

BADGINGSYSTEM

PERFORMANCE BASED REPORT


BA

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AD

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IND

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LC

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Establish clear roles of a

relationship to the CHW (e.g. how often they see

Ensure a continuous support and supervision through meetings at defined intervals (e.g.

Set clear roles and responsabil-

Address restocking by using data to make e!ective forecasts.

Maximize resupply e"ciency by communicating availability of stocks.

Bring the supplies as close as possible to CHWs by leveraging

Optimize access and system e!ciency

Enhance the community perception of the role of CHWs through branded materials.

Give visibility to the CHW-enabled outcomes inside the community.

Celebrate & reward the work of CHWs

Establish a clear career path based on personal inclinations and impact.

Provide incremental training to enrich and evolve competences.

Establish a clear career path


Framework | Sample applications: country mapping

COUNTRY ASSESSMENT


Framework | Sample applications: mapping private providers or other actors (Supervisors)

TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDINGRECRUITING UPGRADING

INDIVIDUALCOMMUNITY

CHP

SUPERVISOR SUPPLIERHEALTH CENTER

SUPPLIES

ASSESS& TREAT

TRUST

REPORT

COACH

REPORT

DIAGNOSTICS TOOLS ENABLERSCOMMODITIES

SUPPORT


HEALTH RELATED GOODS

SERVICES

LG BRANCH

INDIVIDUAL CHWCOMMUNITY

SUPERVISOR

SUPPLIES

ENGAGE

INFORM

COACH

REPORT SUPPORT

REPORT

REPORT

SUPPORT

SUPPLIERHEALTH CENTER DISTRICT

MAPPING OTHER PROVIDERS

MAPPING OTHER USERS

MAPPING PRIVATE OPPORTUNITIES


Tools | The Backpack PLUS Experience

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Starting from core CHW needs highlighted during field research we identified opportunities to improve the quality of the solutions they are provided. Integrating physical tools and mobile-enabled services into one cohesive experience will positively impact community health outcomes.

From Research Insights to Holistic Solutions

TOOLS & PRINCIPLES

I try to visit my CHWs once a month but often I don’t really have time

CHW SUPERVISOR

JassimPeople call me ‘village doctor’

HIGHER-SKILLED

CHW

Gaye


Tools | CHW Archetypes

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The health of my community is the most important thing for me

LOWER-SKILLED

CHW

CLINIC-BASED

CHW

Maliki

Without sensitization, people wouldn’t come to the health post

Fatima



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Roles and responsibilities of CHWs vary greatly across programs and geographies, but common archetypes exist.

TREATMENT (iCCM)

HIGHER-SKILLED CHWLOWER-SKILLED CHW CLINIC-BASED CHW CHW SUPERVISOR

Lower-skilled CHWs provide Health Education to their communities, and are highly mobile, operating most of the time on the go, and focusing on social gatherings.

Higher-skilled CHWs are trained to cover iCCM duties. They tend to operate out of their homes, hence needing to also store large quantities of commodities and tools.

Clinic-based CHWs operate out of rural Health Posts, where they support medical professionals. They usually have their set of supplies, but can easily restock at the Clinic.

Supervisors monitor and mentor groups of CHWs. They are or have been CHWs themselves. They are usually based out of a clinic, but have to regularly visit their CHWs.

HEALTH EDUCATION

SUPERVISION



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All Archetypes share a common set of needs.The context they operate in has a strong influence on the set of tools they tend to use.

TREATMENT (iCCM)

HIGHER-SKILLED CHWLOWER-SKILLED CHW

HEALTH EDUCATION

CLINICON THE GO HOME

CLINIC-BASED CHW CHW SUPERVISOR

SUPERVISION


Tools | The Backpack PLUS System Overview

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Tools | Issues Highlighted During Field Research

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“The job aid is our Bible”CHW (UGANDA)

Current tools and process meant to support CHWs are fragmented, often a!ecting e!ectiveness and undermining motivation.

01


Tools | Opportunities: The Backpack PLUS Experience

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Referral tools are also integratedMobile-enabled assessment tools

From a disconnected set of diagnostic tools and medical commodities to a well-orchestrated experience that improves CHW e!ectiveness.

Consistent packaging design

An integrated approach to information-gathering tools, diagnostic devices, mobile-enabled services and medical commodities will guide service delivery during a visit, streamlining workflows and increasing patient and community trust in the indications provided by CHWs.



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“The bag I was given is big and bulky, I never need to carry that much.”CHW (UGANDA)

Storage and carrying solutions for tools and commodities aren’t flexible enough and do not support CHW workflows

02



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From generic storage and carrying solutions to a system designed to easily adapt to evolving CHW needs.

A long-term storage solution for supplies and commodities at home that’s fully integrated with a carrying solution for visits on the go will improve CHW e"ciency. Flexible compartments will support varying loads, while dedicated areas for “assessment” and “treatment” will better support CHW workflows.

Integrated home and on the go solutions Flexible loading capacityA modular home storage system

Data that is currently generated by CHWs and other actors in the system is not consistent and seldom turned into useful information.



36

“The data collected here is always incomplete.”DISTRICT MANAGER (SENEGAL)

03



From one-way data flows to closed and e!ective feedback loops that provide real-time access to essential information.

Integrated analog and digital reporting toolsCommunity performance boards

An integrated information management approach that flexibly accounts for analog and mobile-enabled workflows will provide timely feedback loops to all relevant actors in the system.Real-time stock tracking and access to patient information willimprove CHW e!ectiveness while addressing current stockmanagement issues.

CHWs are asked to cover an ever-increasing variety of health domains, from iCCM to family planning and HIV prevention, not always properly supported by training and adequate tools.



“New training means that they are investing in us!”CHW (SENEGAL)

38

04



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From irregular training sessions to a continuous learning model that targets CHWs but also accounts for the need to educate their communities.

A flexible and scalable training curriculum that combines longer immersions with ad-hoc modules will create opportunities for CHWs to “learn on the go” and constantly improve their skills over time.Mobile-enabled media will allow CHWs to repurpose their training materials to educate their communities in return.

Checklists and reminders Real-time support services Mobile learning services

Current incentive programs - monetary or otherwise - often fall short of being perceived as making the di!erence in the lives of CHWs.



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“These people put in their own money to do their job!”CLINICAL OFFICER (UGANDA)

05



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Custom home signage

From fragmented incentive programs to a clear hierarchy of roles, responsibilities, benefits and opportunities for growth over time.

A reward and incentives architecture that feels like a career path will help in retaining CHWs, while motivating them to improve their performance.Clearly defined CHW “maturity models” can help mitigate di!erences across programs and geographies, provide clear expectations for CHW growth and improve Supervisor e!ectiveness.

Transportation aids Supervisor pin

SUPERVISOR

Fragmented or ine"cient supply chains can result in perceived lack of CHW support, and undermine the level of trust they need to be e!ective.



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“Why should I walk to the clinic if then they don’t have medicines?”CHW (SENEGAL)

06



From closed ecosystems to integrated public and private sector initiatives aimed at better supporting CHWs and Supervisors.

A system where public sector programs work in synergy with private sector initiatives will - amongst others - contribute to reduce the risk of stock-outs, create opportunities to o!er new incentives to CHWs and o!er private Supervisor programs for improved management of CHWs.

Guidelines and standards Nike backpack production DHL network distributing commodities



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45



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Pneumonia

FROM 2 TO 11 MONTHS

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Pneumonia

FROM 2 TO 11 MONTHS

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TYPOGRAPHY

COLOR PALETTE

ICONS

Noto Sans Bold

Noto Sans Bold ItalicNoto Sans Regular

MAIN TEXT

SECONDARY TEXT

MAIN DISEASES GENERIC DISEASE

MAIN DISEASES

GENERIC DISEASE



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Backpack Plus | Impact

48

Backpack PlusProjected Impact

More cases treated

Higher e"ciency thanks to a more streamlined workflow

Increased e!ectiveness thanks to easier assessment and treatment tools

Increased motivation due to better support and diversified incentives

Increased community trust thanks to better communication

Better quality of care

Reduced error rates thanks to improved tools and higher guidance

Better treatment thanks to enhanced guidance and real-time support

Higher-skilled CHWs thanks to continuous training and supervision

Reduced stock outs thank to improved data management and private sector partnerships

T h a n k s

roberta tassi / using a human-centered design process to drive healthcare innovation: the unicef...

Health & Medicine

design thinking

design firm

design principlesbiocat

design activities

humancentered design

senior design researcher

humancentered design

outcomes data