Project Everest

Experiment Results

[EXPERIMENT RESULTS]: MVP; Utility Testing with Clinicians PHASE 1: Interviews - Health Malawi July 2019

Reference to Experiment Post:

https://projecteverest.crowdicity.com/post/2106920

 

This experiment was conducted to identify whether clinicians value engaging with a tech based solution that streamlines patient data through the healthcare system.

 As a component of the utility testing phase, the aim of this experiment was 2 fold:

 Firstly, the experiment aimed to validate the assumptions that clinicians see high utility in addressing clinic overcrowding, long patient waiting times and the inefficiencies of the overburdened and under resourced. data flow process. 

 Secondly, the interview acted as a preliminary meeting in order to set up focus groups to be conducted in clinicians in the respective clinics. Clinician focus groups will allow assumptions to be tested regarding MVP value and suitability, whilst the preliminary interview provided a sound contextual understanding for the direction to be taken in focus groups. 

 These objectives were achieved by conducting 3 interviews with various senior clinicians. 

 Lean Phase: Solution / Utility Testing

 Assumption:

3 primary assumptions were established prior to conducting the experiment:

  1. Clinicians see high utility in a service which will reduce clinic congestion.

  2. Clinicians see high utility in a service which will optimise patient consultation times. 

  3. Clinicians see high utility in a service which will enable efficient data transfer within healthcare system. 

 

Results:

 From the data collected, the green light success metric has been achieved. Previously made assumptions were validated, whilst focus groups were organised which will allow an ideal environment for MVP and value proposition testing. 

 From these initial meetings, all of clinicians engaged with individually saw value in addressing congestion, optimising consultation times and improving patient data processes from the community to facility level and from the facility level to the district level. 

 Individual Meetings were conducted with:

- Ndirande Health Centre: Head Clinician, Veronica Ngima

- Chileka Health Centre: Head Clinician, Twaibu

 

Learnings:

→ Clinician access to Patient Data: patient history & demographics 

Prior to consultation, clinicians have no information about a patient’s history or current symptoms. Approximately 2 minutes (varies based on total consultation time available) is spent at the beginning of each consultation understanding the patient (before deciding whether to send the patient for further testing or providing a diagnosis/treatment). The important data points which clinicians address are:

- Age

- Gender

- Pregnancy status

- HIV status

- Religion

- Symptoms

With an average consultation time of 5 minutes, up to 40% of the consultation is spent understanding the patient’s demographics and personal data. All clinicians interviewed confirmed the assumption that having access to patient information via technology, prior to consultation, would drastically improve quality and efficiency in consultation times.

The current patient data system is as follows: Doctors may record patient notes in paper forms; but these are solely for their own use. After consultation, patients will report to the data clerk to have their diagnosis & demographics recorded. 

 This information is recorded in a paper register or into the Baobab J2 system. Monthly, this data is sent as aggregate data to the DHO for data analysis. This data is inputted into the DHIS2 at the DHO level and is not accessible by clinics.

 

→ Patient Literacy

Previous teams have identified poor medical literacy as being a key challenge within the healthcare system; an assumption that has been affirmed in conducting this experiment.  

Clinicians interviewed expressed the importance of education (which is not adequate) and explained that educational programs (IECs) are conducted by clinicians in regard to particular diseases, whilst HSAs run similar programs in regard to sanitation/water quality and infant health. 

It was estimated that 40% of patients make unnecessary visits to any given clinic each day. 

 

As clinicians are significantly overburdened,  patients presenting unnecessarily is a major factor contributing to short consultation times and overcrowding. Clinicians affirmed that more efficient quantity and quality of patient data flows and education is essential to combat this.

→ Patient Learning

Clinicians confirmed that if patients are prescribed a drug that is generally available, they will not return to the clinic for the same condition but treat themselves at home instead. However, many patients will not accept an outcome from clinicians if they are not prescribed a physical treatment. Patients will often go from one clinician to another to seek medication, until they receive a treatment. 

Clinicians feel that it is not their responsibility to teach the populous, but rather to consult with individual patients. 

→ Workload & pre-diagnostic data 

Clinicians emphasised that the most significant challenge faced is the overwhelming workload. Clinicians identify a high utility in being able to access patient data prior to consultation and in developing a system by which unnecessary patient visits are minimised. Access to patient data is regarded as improving accuracy of patient diagnoses and reducing consultation times. 

Furthermore, a comprehensive data system which could be accessed by mobile phone was seen as extremely valuable as it would facilitate patient learning and stop patients from moving between clinics when not prescribed medicine.

There was enthusiasm for a pre-triage USSD system being used within the clinic at the start of the day, in conjunction with HSAs using a similar system in the community during their patient consultations. 

Due to a lack of patient data, clinicians often spend time running medical tests such as a patient’s blood-sugar with patients as it can be a more efficient process than extracting a patient's medical history and past symptoms. 

Clinicians also attempt to alleviate this lack of information through the use of various smartphone applications including whatsapp to contact one another with patient information. 

 Clinicians  interviewed were content with the prospect of accessing patient information either with a USSD interface, receiving text messages or through a smartphone application. The clinicians interviewed owned smartphones and use them extensively for work purposes. The assumption that there is a high penetration rate of smartphones for clinicians will be validated in phase 2.

 

Validated Learning:

As a result of the experiment, it was discovered that clinicians not only have large challenges with their workload and access to patient data, but they are keen to address this challenge. Clinicians are willing to use a system which will reduce congestion at clinics or optimise consultation times, and see great value in a system that will streamline and digitise patient data processes. 

 

 The health team was also able to build relationships which would lean to valuable focus groups being conducted in the future.

 

Next Move:

Following the preliminary meetings, utility testing can be conducted with clinicians through a focus group structure. This will involve building desire for a tech solution, whilst understanding where the value lies in a tech solution for pre-triage and data transfer.

 

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Isabella Strapp 1 month ago

Status label added: Experiment Results

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