Abstract:
Background: Newborn mortality remains high in Kenya with a majority of the deaths occurring due to preventable conditions. Health workers can learn from these deaths to improve their care quality and prevent subsequent deaths from similar causes. Clinical audits are a quality improvement intervention that enables health workers to systematically reflect on their practice and identify and act on modifiable gaps in the care provided. For effectiveness, the clinical audit must use a structured tool that comprehensively covers the continuum of newborn care. There were no identified audit tools designed to audit the in-hospital care of the SSNBs beyond the period of immediate resuscitation. Therefore, the aim was to codesign a newborn clinical audit tool and its implementation guide that considers the health workers' basic needs, capabilities, and limitations by applying the key principles of a human-centred design (HCD) approach.
Study methods: A three-step HCD approach was employed and situated in two high-volume public hospital NBUs in Kenya with newborn care workers as the study participants. The first step involved understanding the context, the users, and the available audit tools through literature, focus group discussions and a consensus meeting that led to the development of a prototype audit tool and its implementation guide. The second step was a cognitive walkthrough. This involved continuous iteration through a cyclic process of evaluating the usability of the prototype audit tool with the end users on real cases in the newborn unit and refining this based on their feedback. The final prototype tool and the implementation guide were then tested in the two newborn units to determine their usability. The outcomes of interest were a comprehensive and usable SSNB audit tool and a context-sensitive implementation guide.
Results: A SSNB audit tool that considered (i) human factors that influenced interaction with the tool such as reduced free text for ease of filling, (ii) usability which catered for the comprehensiveness of the tool and, (iii) user experiences such as length of the tool. An implementation guide that ensured a favourable learning environment, gave guidance on the frequency of the meetings, the number and selection of cases for each meeting, and guidance on implementing action plans.
Conclusion: The Human-Centred Design approach enabled the development of a high-quality audit tool and implementation guide that can achieve its intended goals with efficiency, effectiveness and satisfaction while considering the capabilities and limitations of the end-users within their context.
Audience Takeway
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This will provide a solution to the design of quality improvement innovations that are usable, context-sensitive, and acceptable to health workers.
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The audit tool was designed to cover all the aspects of newborn care and is therefore adaptable to settings with a high burden of preventable newborn morbidity and mortality. The implementation guide is also suitable for busy settings with health workforce shortages.
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In several countries, the maternal and perinatal death review process has improved the quality of care and subsequently reduced maternal mortality. There is, however, evidence that the perinatal aspects of the reviews are not given as much attention as the maternal aspects. This newborn clinical audit complements the existing perinatal review processes to strengthen the audit of newborn care.
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The newborn clinical audit will enable the health workers to use a systems approach to identify the underlying factors influencing newborn quality of care. This will ensure that the health workers strengthen the gaps that weaken the health system.
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Both the clinical audit and the human-centred design approaches strengthen teamwork and communication, therefore, building more resilient and effective teams.
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This will demonstrate the importance of supportive leadership in improving newborn care quality and encourage the leaders in the audience to be advocates for newborn care.
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This can be incorporated into quality improvement curricula..
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The design approach used is practical, cost-effective and utilizes the available resources
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In health care, the culture has largely been to train health workers to adapt to poorly designed interventions that are not sensitive to the context. The methods used in the design benefit from the end user’s knowledge and designing interventions to suit people’s needs.
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End users understand where the real gaps are, therefore, involving them in the design focuses on designing an innovation that solves the right problem.
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The use of real cases in the design of a quality improvement initiative for a complex system provides more accurate and detailed information about the experiences and problems that can occur.
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The audit tool was designed as an electronic tool allowing for hybrid meetings.
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Properly conducted newborn clinical audits can reduce preventable newborn mortality as evidenced by the role maternal audits played in reducing maternal mortality.
