Table 1 Groundwork phase—activities and domains for the development of the Better Hearts Better Cities initiative in São Paulo, Brazil
From: Deconstructing design thinking as a tool for the implementation of a population health initiative
Process phase | # | Activity | When | Main actors | Dose/input (time required to develop/implement or activity frequency) | Target (of action; unit of analysis) | Actions (brief) | Purpose (brief) | Expectation/outcome (brief) |
|---|---|---|---|---|---|---|---|---|---|
Groundwork | 1 | Targeting Brazilian cities | 2016/2017: Salvador da Bahia, Rio de Janeiro, São Paulo | NF | Field visits, follow-ups. Total of approx. 3–4 months | Ministry of Health (Dept. of Primary Care and NCDs) and city health authorities | Building the case with key leadership figures | To identify a suitable city to run the BHBC initiative | Critically discuss opportunities; identify appropriate target city; obtain permission to engage |
2 | First touch points | June–July 2017 | NF | Concept note: 1 month field visits, virtual networking and country representatives One meeting (City Hall) | Primary care and NCD focal points in local government | Encourage São Paulo to be part of the BHBC initiative | Recognize role of local leaders, demonstrate systems perspective and understand challenges; promote partnership | Generate enthusiasm and stimulate discussion, leading to a letter of intent | |
3 | Field visit I: launch visit and feasibility analysis | 25 Jul–4 Aug 2017 | NF | 11 days | Ecosystem stakeholders (hospitals, academics, primary care providers, politicians) | Extensive stakeholder mapping and situation analysis | Introduce initiative and identify support; start to frame implementation format | Establish working groups; confirm buy-in; identify possible champions; co-create target activities, locations and groups | |
4 | Stakeholder meetings and workshops | Between 2017 and mid-2018 | NF | 2017/2018: approx. every 3Â months | City Hall | Keeping stakeholders up to date and ready for new insights | To maintain relationships and create a platform to showcase value-add in the face of changing political contexts | Build relationships and establish strong engagement at the local operational level | |
5 | Field visit II: Stakeholder consolidation and alignment | 14–29 Sept 2017 | NF | 2 weeks | Secretary of Health; potential local partners; primary healthcare providers; situational assessment partner | Stakeholder engagement; understanding context | To share decision-making, remain sensitive and responsive to needs, promote compatibility across the initiative | Consolidate high-level commitment to the initiative and working partnerships; check in on current activities | |
6 | Field visit III (A): tender process and preparatory meetings | Full tender process: Nov 2017–Jan 2018 Field visit: 6–15 Dec 2017 | NF | 9 days Several preparatory meetings 1 workshop (district officials, Santa Marcelina and Tellus) (see below) | Public agents responsible for primary care and NCDs in local government | Selection of implementation partner and governance committees | Formalize commitment to the initiative, including shared decision-making | Selection of implementation partner and sites; confirmation of committee members; local government acceptance of preconditions | |
7 | Field visit III (B): workshop with technical leads | 14 Dec 2017 | NF with support from Tellus team | 1 half-day (4Â hours) | Representatives with coordinating, strategic, technical and medical roles | Kick-off workshop with technical leads | Open forum to discuss predefined questions and encourage further inquiry to address doubts and concerns | Introducing the initiative and informing strategic action; exchange between actors to promote trust and positive engagement | |
8 | Project kick-off | 23 Feb 2018 | Tellus team | Workshop preparation: 10 days Workshop: 1 day | – East zone coordination – Itaquera supervisors – Social organization partners – Government representatives | Project kick-off with Tellus | Build relationships amongst stakeholders, confirm next steps | Validation of schedule and process; strengthening of relationships; ownership |