Presentation
Making Protocols Practical: Designing a Human-Centred Model of Care to Reduce Maternal Morbidity and Mortality
SessionPoster Session 1
DescriptionThe McGill University Health Centre (MUHC), a tertiary care hospital in a downtown, urban core, partnered with a newly created national Knowledge Mobilization Hub and Healthcare Human Factors (HHF) to develop a human-centred approach for implementing healthcare changes and integrating evidence-based practices into clinical care. The Maternal Early Warning Signs (MEWS) Evidence-Based Practice implementation at the MUHC enabled the design and testing of this bespoke human-centred design process to improve quality of care. In order to consider how to implement MEWS, we wanted to alter the way change is implemented in healthcare.
The MEWS protocol is an evidence-based practice that supports clinicians in operationalizing a supportive, proactive, and collaborative model of care with the goal of decreasing severe maternal mortality, and maternal morbidity. Deeply exploring the current lived experiences of clinicians (nurses, residents, staff physicians, nurse managers, and everyone working on the floor) allowed for us to identify gaps and opportunities for improvement, and highlight where significant changes would be needed to support the uptake of MEWS, including the design and delivery of training and education to meet those needs.
A human centred approach means putting people at the centre of the process. This framework focuses on designing with empathy to understand the lived experience of those facing a problem, change, or product and then having them engage in co-creating the solutions to pave the way for more successful uptake, impact, and sustainability. We began this work with a robust discovery process, engaging with multiple front line healthcare providers through one-on-one semi structured interviews, and facilitated virtual and in-person exploratory workshops,. We also immersed ourselves into the clinical setting, spending multiple days observing the labour and delivery, and postpartum units examining with a human factors lens to understand how staff worked.
From there we dove into a Co-Design phase where we really engaged creatively with key end users and clinical teams. Engaging frontline clinicians can be challenging due to their demanding schedules and limited availability during shifts. To ensure their perspectives were included in our brainstorming sessions, we employed a variety of engagement methods including on-the-fly engagement and testing activities on the unit.
In order to engage with clinical teams we organized:
In-person workshops in the hospital, outside of the clinical unit
Sessions on clinical units at nursing stations where workshop content was directly delivered
“Pop Up” testing at nursing stations
Feedback stations in break rooms to connect with those working night shifts
We engaged with people with lived experience of pregnancy separately from clinical teams to ensure we were using a trauma-informed approach and being respectful of their experiences of pregnancy and birth. It was critical that we be mindful of any potential past traumas that our engagement might trigger. We wanted to offer a creative, safe, and flexible way for participants to provide feedback on designing patient-facing solutions. Participants were sent a digital package or Cultural Probes, which included various activities to complete at their convenience within a 2 week timeframe. Following this, we conducted a 1-hour virtual collaborative session to discuss our findings and delve deeper into their desired future experiences.
Through this work we discovered that this ‘practice change’ was actually going to result in a transformative model of care, poised to become a cornerstone in pregnancy care, maternal health, obstetrics, and childbirth units. The new protocol emphasizes safe, proactive, and collaborative care, where patients are integral members of the care team.
In this model, every individual has a distinct role, working together to create positive experiences for both clinicians and patients. This collaborative approach ultimately reduces the risk of severe maternal morbidity and mortality.
Through our engagement four guiding principles of MEWS emerged:
Provide simple and clear communication
In hospitals, patients and their support people face a lot of distractions and there are many unknowns. Providing small tasks and informing them about concerning signs and symptoms helps them focus and feel more in control. To feel empowered they want to be included, given clear tasks, and encouraged to voice concerns.
Provide quick access to important information
We heard that being in hospital can be scary, but it is the lack of information, not the possession of information that feels vulnerable. Patients and support people want to be empowered with information and acknowledged when they are providing updates so that they feel heard and included.
Create a safe, judgement free environment
People wanted to feel safe and cared for, included, respected in a judgment free and supportive space. People do not want to hear themselves be called “mama, or mommy”, they want to be seen as individuals and called by their name.
Encourage a collaborative environment
We heard that patients’ concerns often feel disregarded when they are trying to advocate for themselves. They often feel that they are treated as a body rather than a human. Patients need to have their autonomy and voice respected. They need to be involved in clinical discussions, and they should always be consulted prior to any procedure or task being performed on them.
Using learnings from our design process we were able to create a thoughtful education plan for the clinical team, with a range of recommendations for them to take into consideration when designing their education curriculum.
We are so excited to share this important work.
The MEWS protocol is an evidence-based practice that supports clinicians in operationalizing a supportive, proactive, and collaborative model of care with the goal of decreasing severe maternal mortality, and maternal morbidity. Deeply exploring the current lived experiences of clinicians (nurses, residents, staff physicians, nurse managers, and everyone working on the floor) allowed for us to identify gaps and opportunities for improvement, and highlight where significant changes would be needed to support the uptake of MEWS, including the design and delivery of training and education to meet those needs.
A human centred approach means putting people at the centre of the process. This framework focuses on designing with empathy to understand the lived experience of those facing a problem, change, or product and then having them engage in co-creating the solutions to pave the way for more successful uptake, impact, and sustainability. We began this work with a robust discovery process, engaging with multiple front line healthcare providers through one-on-one semi structured interviews, and facilitated virtual and in-person exploratory workshops,. We also immersed ourselves into the clinical setting, spending multiple days observing the labour and delivery, and postpartum units examining with a human factors lens to understand how staff worked.
From there we dove into a Co-Design phase where we really engaged creatively with key end users and clinical teams. Engaging frontline clinicians can be challenging due to their demanding schedules and limited availability during shifts. To ensure their perspectives were included in our brainstorming sessions, we employed a variety of engagement methods including on-the-fly engagement and testing activities on the unit.
In order to engage with clinical teams we organized:
In-person workshops in the hospital, outside of the clinical unit
Sessions on clinical units at nursing stations where workshop content was directly delivered
“Pop Up” testing at nursing stations
Feedback stations in break rooms to connect with those working night shifts
We engaged with people with lived experience of pregnancy separately from clinical teams to ensure we were using a trauma-informed approach and being respectful of their experiences of pregnancy and birth. It was critical that we be mindful of any potential past traumas that our engagement might trigger. We wanted to offer a creative, safe, and flexible way for participants to provide feedback on designing patient-facing solutions. Participants were sent a digital package or Cultural Probes, which included various activities to complete at their convenience within a 2 week timeframe. Following this, we conducted a 1-hour virtual collaborative session to discuss our findings and delve deeper into their desired future experiences.
Through this work we discovered that this ‘practice change’ was actually going to result in a transformative model of care, poised to become a cornerstone in pregnancy care, maternal health, obstetrics, and childbirth units. The new protocol emphasizes safe, proactive, and collaborative care, where patients are integral members of the care team.
In this model, every individual has a distinct role, working together to create positive experiences for both clinicians and patients. This collaborative approach ultimately reduces the risk of severe maternal morbidity and mortality.
Through our engagement four guiding principles of MEWS emerged:
Provide simple and clear communication
In hospitals, patients and their support people face a lot of distractions and there are many unknowns. Providing small tasks and informing them about concerning signs and symptoms helps them focus and feel more in control. To feel empowered they want to be included, given clear tasks, and encouraged to voice concerns.
Provide quick access to important information
We heard that being in hospital can be scary, but it is the lack of information, not the possession of information that feels vulnerable. Patients and support people want to be empowered with information and acknowledged when they are providing updates so that they feel heard and included.
Create a safe, judgement free environment
People wanted to feel safe and cared for, included, respected in a judgment free and supportive space. People do not want to hear themselves be called “mama, or mommy”, they want to be seen as individuals and called by their name.
Encourage a collaborative environment
We heard that patients’ concerns often feel disregarded when they are trying to advocate for themselves. They often feel that they are treated as a body rather than a human. Patients need to have their autonomy and voice respected. They need to be involved in clinical discussions, and they should always be consulted prior to any procedure or task being performed on them.
Using learnings from our design process we were able to create a thoughtful education plan for the clinical team, with a range of recommendations for them to take into consideration when designing their education curriculum.
We are so excited to share this important work.
Authors
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments