How might we support clinical champions in low-resource settings as they
venture to implement the WHO's safe surgery checklist in their hospital?
Implementation of the safe surgery checklist—developed by the World Health Organization (WHO) to improve surgical outcomes—is inconsistent. The road to implementation is complex, time-consuming, and resource intensive. Hospitals report “checklist fatigue” before they’ve used the checklist with a patient. The Lifebox Foundation recognizes that clinical champions are crucial to implementing safe surgery practices in low-resource settings. The organization partnered with us to identify opportunities to improve its training materials used to support clinical champions implement the WHO safe surgery checklist in their hospital.
Challenges included: (1) working with a globally distributed, resource-limited team, our partners were based in London and our end-users were located in Africa, and (2) creating interventions in an environment with strict hierarchies and long-standing cultural beliefs about the practice of surgery.
Our offerings included a re-designed five-step implementation guide, guidelines for an online peer community, and programmatic interventions to incentivize implementation.
Partners: Lifebox Foundation
Role: integrative designer working with four integrative designers
Extent of the project: six and a half weeks, part-time
Tags: systems thinking, design research, user-centered design, journey mapping, insight generation, behavior change, consulting
Design Process.
This project followed a modified double-diamond process where we completed the Research and Design phases of this project, and our project partner, Lifebox Foundation, is evaluating the guide in the field.
Research.
We applied a systems thinking model to identify gaps in the current training material and the supporting resources, to better equip the organization to adopt a user-centered approach to their implementation efforts.
We re-framed the problem from developing products to re-configuring systems and scoped the project considering stakeholder needs. We conducted remote expert interviews with champions around the world and also read through more than 700 pages of guides, research findings, and publications to help ground our work. We synthesized our learnings into: need statements, diagrams, and a journey map to develop a shared mental models amongst our global team.
Why a journey map?
The journey map became a valuable communication tool with our partners as it put a renewed focus on the needs of the clinical champion. Creating it helped us pinpoint stages where champions needed more support, and led us to identify key instances where champions felt overwhelmed by the task.
What is a node diagram?
The node diagram helped us take stock of, and organize, all the steps required for sucessfully implementing the safe surgery checklist. The diagram became the skeleton of the re-designed implementation guide.
Journey map of a clinical champion going through the implementation process with stages, emotional responses, and existing touchpoints highlighted.
We compiled all existing resources and steps required in implementing the safe surgery checklist into a comprehensive node diagram. It made visible the complexity and the burden of championing the checklist.
Design.
We took our findings from research and developed them into eight key insights about the implementation process. This focused us on idea generation within those
areas using paper prototypes and user scenarios. We shared our recommendations using concise digital visualization of solutions.
Brainstorming ways to address our insights, led to the design of a five-step implementation guide, guidelines for an online peer community, and programmatic interventions to incentivize implementation. The five-step guide re-framed the checklist from a punitive measure into a tool that could help patients, clinicians, and the hospital. It gave champions agency to set their own path when possible, and utilized existing resources (from the Lifebox Foundation & Peers). We developed guidelines for a global summit, fellowship program, and an online community as pull mechanisms that could also become “think tanks” for the organization.
The eight key insights we developed after synthesizing our research helped guide our brainstorming and design efforts. They also communicated challenges with Lifebx's current implementation process.
The quickstart guide contained resources for clinical champions including a high-level introduction to implementation process, activities, and additional resources available to them.
The guide is being tested and evaluated by the Lifebox Foundation in the field.
"We have shared the implementation materials with our Tanzania team. It is being appreciated and
very much helping to frame some of the thinking on the ground."
—Director of Communications & Strategic Partnerships, Lifebox Foundation