Transforming Tuberculosis Care

Visiting the TB Clinic: observation began in the wait room to understand the patient experience

Visiting the TB Clinic: observation began in the wait room to understand the patient experience

 

Background: In 2013 I was approached by Johnson & Johnson with the opportunity to help develop a concept and strategic plan for their global health team. Having recently developed the first new TB (tuberculosis) vaccine in 40 years, Johnson & Johnson was looking to create a plan to distribute this medicine in Uganda while supporting proper medicine adherence. Medicine adherence is important because when the full course of medicine is not followed, the TB becomes drug resistant, and drug resistant TB is a major public health problem that threatens progress made in TB care and control worldwide.

Client: Johnson & Johnson

Consultancy: (self)

Project Length: Two Weeks

  • One week prep and desk research
  • One week field research and workshop

The Team:

  • From Johnson & Johnson: Project Lead, Software Engineer, Physician, Business Analyst
  • Ugandan Stakeholders: Physicians (3), nurses (5) , TB patient, health administrators (5), representatives from partnering organizations (HIV services, infectious disease clinic, blood bank) (8)
  • UX designers (2)

Personal Contribution:

  • Participate in the prep and research
  • Facilitate one-day workshop with 25 participants
  • Ongoing support as needed

Deliverable: A concept and strategic plan for an integrated TB care plan

 

 

WEEK 1 (Prep and Desk Research)

Personal Contribution: conducted desk research and Skype meetings with the global health team to:

  • Gather background
  • Build quick domain understanding
  • Problem frame
  • Create shared definition of goals & desired outcomes
  • Build rapport 
 

 

WEEK 2 (Field Research and Workshop)

Following the data: observing how patient records move through the clinic and then to the archive room

Following the data: observing how patient records move through the clinic and then to the archive room

Interviewing a nurse: an explanation of one of the many patient forms.

Interviewing a nurse: an explanation of one of the many patient forms.

 

Field Research

Personal Contribution: visited 2 TB clinics (one urban, one rural) to:

  • Observe the patient journey from the wait room as a new patient through receiving care
  • Interview doctors and nurses about TB care in Uganda including treatment flow, breakdowns and successes
  • Follow the patient data (paper records) i.e. the record movement, access and archival processes

Surprise Finding!

While approaching the problem, the global team had hypothesized that to support the admin. side of TB care, they should develop desktop and mobile apps to manage the patient records digitally. During field research it was discovered that the current paper patient records work really well. Conclusion: do not alter the current patient record process.

 

 

The Workshop

Personal Contribution:

  • Create agenda
  • Select appropriate methods and frameworks (shown below)
  • Facilitate workshop activities while sketching maps and diagrams (shown below)
  • Foster an inclusive environment & support participants through the workshop process
 
Rules with a positive tone encouraged participants to share their expertise and ideas.

Rules with a positive tone encouraged participants to share their expertise and ideas.

Method: stakeholder map. Drawing a map of the stakeholders helped frame the problem as part of a large system.

Method: stakeholder map. Drawing a map of the stakeholders helped frame the problem as part of a large system.

Method: user journey map. Together the group shared their deep expertise around the patient journey to build empathy and shared understanding.

Method: user journey map. Together the group shared their deep expertise around the patient journey to build empathy and shared understanding.

Method: Idea matrix. In small groups, teams worked to complete their idea matrices. The top row represents topics related to patients, the left column represents different channels for solutions. The team with the most ideas won a prize (chocolate).

Method: Idea matrix. In small groups, teams worked to complete their idea matrices. The top row represents topics related to patients, the left column represents different channels for solutions. The team with the most ideas won a prize (chocolate).

Framework: The Hook. Participants used this framework to develop concepts that inspire habitual behavior change.

Framework: The Hook. Participants used this framework to develop concepts that inspire habitual behavior change.

Method: Personas helped participants ideate solutions for specific goals and behaviors of different patient types.

Method: Personas helped participants ideate solutions for specific goals and behaviors of different patient types.


 

The Outcome

After working in small teams to ideate and develop concepts for an integrated TB care plan, the group voted to decide which of the concepts to prototype. The voting process ended in a tie and it was decided that the team would pursue the top two concepts and evaluate those concepts after the prototype process. The solutions include a combination of mobile apps, sms services, analog record keeping tools, kiosks for dispensing medicine, rewards for participation, and collaboration amongst partnering patient care organizations. The prototypes are currently under development.

 

Client Feedback

“I just wanted to reach out and personally thank you for your ongoing support of our efforts in Uganda, and especially for running an excellent workshop last week.  We’re all very pleased with the results and went home with a strong concept in mind! “
Stephen, Sr Analyst