From: Deconstructing design thinking as a tool for the implementation of a population health initiative
Process phase | No. | 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) |
---|---|---|---|---|---|---|---|---|---|
Exploration | 14 | Observational research: A day in the life of CHAs | Mar 2018 | Tellus team | 100 visits were shadowed | – CHAs (from two pilot sites) | Observational research | Build empathy with key stakeholders | To extend user-focused research and insights generation Direct engagement with stakeholders to build empathy and promote trust |
15 | Field research and interviews | Mar–Apr 2018 | Tellus team | 6 days in total—1 day per pilot health unit | – Itaquera community – HTN patients – Pilot health units and staff | Field research—system structure and dynamics | Build a dynamic picture of the structural environment influencing the aetiology of HTN | To understand HTN links between establishments within the Itaquera territory and community behaviour | |
16 | Observational participation in activity groups at primary care clinics | Apr 2018 | Tellus team | One activity group observed for 10 hours | HTN patients attending activity Primary care workers (health technicians, CHA, managers) | Observational research—HTN services in primary care | Understanding current patient services and engagement | To understand patient services and health behaviours To build relationships with pilot sites and patient communities | |
17 | Co-creative meetings with managing councils of each clinic | Apr 2018 | Tellus team | 6 meetings with co-creation session; 1Â hour per meeting | Managing councils (healthcare professionals, health system managers and community representatives/clinic users from each UBS) | Co-creation sessions | Check learnings about system and processes; deeper examination of needs and ideas; promote interest for sustainability | To understand system processes and develop and enhance relationships | |
18 | Establishing baselines: questionnaires and desk research | Apr 2018 | Tellus team | 6 days; 8 hours a day | – Primary care workers – Clinic managers | Hard and comparative data at different levels of the health system | Establish baseline for evaluation; extend evidence base to direct action; build relationships | To establish a set of indicators for subsequent evaluation To characterize HTN care and treatment To strengthen relationships | |
19 | Evidence review, co-creative sessions—patient adherence and health information | Apr 2018 | Tellus team | Desk research (10 days) 6 interviews (pharmacists) 6 co-creation sessions (five patients per session) | HTN patients Local population Health information system (secretary, coordination, supervisors, UBS, patient) | Review of evidence on patient adherence, local experiences, health information system | Identify system levers to support patient adherence | To promote evidence-informed (global–local) thinking to support the design of desirable, feasible and acceptable innovations | |
20 | Clinical guideline review and curriculum review | Apr 2018 | Tellus team | 10 meetings with co-creation sessions 18 questionnaires 18 interviews | NF Medical Society Itaquera and Santa Marcelina supervision | Assess clinical guidelines use, professional training and user journeys | To develop guidelines based on understanding of system functioning and system actor perspectives; augment designer–stakeholder relationships | To reach an informed position to redesign guidelines to promote improved execution To show a deep appreciation for user experiences To better understand key challenges and needs | |
21 | Checkpoints | Mar–Apr 2018 | Tellus team | 2 meetings each month (with 1 week of preparation for each meeting) | Itaquera supervisor and supervision managers | Recurring face-to-face meetings with Itaquera technical supervisory team | United project management and team-building | To clarify specific doubts about management and accelerate the exploration process | |
22 | User journey formulation | Apr 2018 | Tellus team | 80 hours | Itaquera HTN ecosystem—people: healthcare workers, doctors, CHAs, pharmacists, patients and managers | Assemble data into visual summary—user journeys | Visual depictions of user experiences as evidence summaries (convergence) and workshop tool to guide co-creation phase (divergence) | To create journey maps for each target actor to inform design thinking | |
23 | Itaquera map | Apr 2018 | Tellus team | 40 hours | Itaquera HTN ecosystem—structure: demographic profile, location of UBS and coverage area, public and private leisure and consumer facilities | Assemble data into visual summary—territorial map | A visual guide to the structural layout of the health ecosystem to identify key targets and change opportunities | To understand the behavioural profile of users based on what services (consumer, health and leisure) are available in the territory | |
24 | Personas | Apr 2018 | Tellus team | 40 hours | Itaquera community members at risk of, or already living with, HTN | Evidence-based creation of target “personas” for HTN | User-friendly evidence summary, educational and co-creation tool | To identify target groups with challenges and behaviours as a tool for informed action in workshops | |
25 | Stakeholder map | Apr 2018 | Tellus team | 80Â hours | Itaquera HTN ecosystem (people and environment) | Visualization of spheres of influence across health ecosystem | User-friendly visual summary and co-creation tool | To present the whole health ecosystem in terms of influential actors to be used as a tool for informed action in workshops | |
26 | Characterization of health system and living environment | Apr 2018 | Tellus team | 80Â hours | Itaquera HTN ecosystem (infrastructure and services) | Visual profiles of pilot health units for intervention | User-friendly educational and co-creation tool | To create a setting-sensitive tool to guide and validate innovation ideas, and inform resource planning and evaluation | |
27 | Development of design principles for the design strategy | Apr 18 | Tellus team | 40Â hours | Tellus team | Empathy, engagement and training as basics for the co-creation strategy | To place empathy and community engagement at the heart of design strategy | To define a set of design principles with the necessary qualities to promote the innovation and implementation process | |
28 | Development of guidelines for co-creation workshops | Mar 2018 | Tellus team | 40Â hours | Future co-creation workshop participants | Guidelines for co-creation workshops based on design principles | To bring all learnings into a concrete form to educate, co-create and reference | To consolidate evidence for reference and educational materials to enable engagement and shift thinking paradigms | |
29 | Phase presentation to steering committee and broader group | Apr 2018 | Tellus team | 1 workshop split into two parts | Part 1: Steering committee Part 2: Meeting with broader group | End-of-phase presentation of project findings for validation and next steps | To complete validation rituals as necessary for the design process | To validate process and target challenges to be taken forward to co-creation workshops |