This blog post originally appeared on the Jacaranda Health Blog on November 18, 2013.
Lyndah & Richard, nurses, discuss the child wellness record
Medical records get a lot of buzz these days. In the past several years the United States Department of Health and Human Services has heavily incentivized private providers to convert paper medical records to electronic systems. Providers in the developing world are tempted with promises of record-keeping magic bullets in the form of handheld tablets, mobile phones, and tele-medicine. But the reality is that you can’t build good electronic records without knowing how to build good paper records in the first place. And most medical records are badly designed. Rarely do we talk about what makes a solid, useful medical record.
How do you thoroughly collect patient medical information while facilitating efficiency during the consultation? How do you empower low-income patients with their own files while retaining copies for yourself? How do you provide guidance to clinicians without making forms unwieldy? We spent the last few months at Jacaranda asking ourselves these precise questions as we redesigned our medical records.
This post was written by Allison Ettinger and originally appeared on the Jacaranda Health Blog.
A new mother and baby at Jacaranda
Joyce*, a healthy mother, glows as she admires her new baby. Her husband collects her belongings as she prepares to leave Jacaranda Maternity, and she hugs the community health worker who provided her discharge education: “See you in a few days,” she says. Most health care providers in Kenya – or across the developing world –would schedule a new mother’s six week postnatal visit, hope she returns for it, and call it a day. Jacaranda thinks otherwise.
Human-centered design (HCD) has been part of Jacaranda’s approach to providing high-quality, affordable maternal health care since our inception. In the past year and a half we have consistently used design sessions to understand healthseeking behaviors and develop our model. During one of our HCD sessions, two participants role-played the typical interaction between a clinician and a patient, demonstrating a “good” and a “bad” nurse. The group then put themselves in the shoes of a patient to envision how they would like to be treated. During another exercise, Jacaranda staff generated strategies for increasing male involvement in maternity care. They talked to men on the street, in barbershops, and in bars to develop a deeper understanding of male views on maternity and how we can provide more inclusive services.We have always been driven by the pursuit of understanding those we serve, and hold the core belief that our clients hold the knowledge about how to best design an effective service delivery system.
When we think of clinical skill building, the first things that come to mind are probably medical training, hands-on simulation, or research. Rarely does it occur to us that some of the most important skills for a provider go far beyond the clinical. At Jacaranda, we believe that safe and respectful maternity care is about more than direct medical service — it’s about taking the psychosocial background of each client into account, from partner support to financial means and family makeup. It’s about communicating to each client with patience, humility, and respect while attending to her medical needs.
