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Development of a small and sick newborn clinical audit tool and its implementation guide using a human-centred design
Muthoni Ogola1,2,3, John Wainaina1, Naomi Muinga1
1Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Insights
A human-centered design approach was used to co-design a newborn clinical audit tool and guide. This ensures comprehensive care for small and sick newborns by addressing user needs and contextual factors.
Area of Science:
- Healthcare Quality Improvement
- Human-Centered Design in Medicine
- Neonatal Care Auditing
Background:
- Clinical audits are crucial for healthcare professionals to improve patient care by identifying and addressing quality gaps.
- Effective auditing of care for small and sick newborns requires a structured tool covering the entire continuum of newborn care.
- Existing audit tools may not adequately address user needs or the specific context of newborn care.
Purpose of the Study:
- To co-design a comprehensive newborn clinical audit tool and implementation guide using a Human-Centered Design (HCD) approach.
- To ensure the tool and guide are user-friendly, contextually relevant, and effectively address the needs of healthcare workers auditing newborn care.
- To improve the quality of care provided to small and sick newborns through a refined audit process.
Main Methods:
- A three-step Human-Centered Design process was employed, including user research, iterative prototyping, and usability testing.
- Literature reviews, focus group discussions, and consensus meetings were conducted to develop an initial prototype audit tool and implementation guide.
- The prototype underwent multiple review cycles with users in high-volume newborn units, incorporating feedback for refinement before final testing.
Main Results:
- User feedback indicated a preference for a comprehensive tool that considered human factors like reduced free text, optimal length, and improved aesthetics.
- The iterative design process led to a refined audit tool and implementation guide tailored to user requirements and practical use.
- Facilitators and barriers to clinical auditing in Kenyan public hospitals were identified and informed the development of the implementation guide.
Conclusions:
- The Human-Centered Design approach successfully facilitated the co-design of a newborn clinical audit tool and implementation guide.
- The developed tool and guide are comprehensive, user-centered, and consider the specific context and requirements of users in newborn care settings.
- This HCD-informed approach offers a promising strategy for enhancing the quality of care for small and sick newborns through effective clinical audits.
Abstract:
Clinical audits are an important intervention that enables health workers to reflect on their practice and identify and act on modifiable gaps in the care provided. To effectively audit the quality of care provided to the small and sick newborns, the clinical audit process must use a structured tool that comprehensively covers the continuum of newborn care from immediately after birth to the period of newborn unit care. The objective of the study was to co-design a newborn clinical audit tool that considered the key principles of a Human Centred Design approach. A three-step Human Centred Design approach was used that began by (1) understanding the context, the users and the available audit tools through literature, focus group discussions and a consensus meeting that was used to develop a prototype audit tool and its implementation guide, (2) the prototype audit tool was taken through several cycles of reviewing with users on real cases in a high volume newborn unit and refining it based on their feedback, and (3) the final prototype tool and the implementation guide were then tested in two high volume newborn units to determine their usability. Several cycles of evaluation and redesigning of the prototype audit tool revealed that the users preferred a comprehensive tool that catered to human factors such as reduced free text for ease of filling, length of the tool, and aesthetics. Identified facilitators and barriers influencing the newborn clinical audit in Kenyan public hospitals informed the design of an implementation guide that builds on the strengths and overcomes the barriers. We adopted a Human Centred Design approach to developing a newborn clinical audit tool and an implementation guide that we believe are comprehensive and consider the characteristics of the context of use and the user requirements.
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