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Patients and families helped one hospital redefine the meaning of quality.
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Is Co-Design the Key to Humanizing Health Care?

By Santiago Narino | Tuesday, November 27, 2018

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A few years ago, when English-speaking IHI faculty first introduced the concept of patient- and family-centered care to partners in Latin America, language interpreters explained the concept as “humanizing” care. This powerful interpretation has spread and captured the imagination of many quality improvement professionals throughout the region.

This includes the staff at the philanthropic Hospital Infantil Napoleon Franco Pareja, the only pediatric hospital in Cartagena, Colombia. With 82 beds and 29 beds in their ICU, they serve around 14,000 cases a month. Most of their patients’ families are among the poorest in Colombia.

Under the leadership of Director of Quality Hernando Baquero, MD, Hospital Infantil Napoleon Franco Pareja. Casa del Niño has transformed care for thousands of children in one of the most vulnerable areas of the city. After a year of using co-design techniques that include design thinking and forms of experience-based design with patients and families, they have enhanced the patient experience, improved the health of the pediatric population they serve, and increased joy in work while lowering costs. They have engaged patients and families in processes that include the design of what quality means and how it should be institutionalized at the hospital. With 10 percent of them trained in humanization strategies so far, staff report feeling happier and turnover is down to under 2 percent.

What Does Quality Mean to Patients?

Progress didn’t happen overnight. After hearing IHI Senior Fellow Don Berwick and IHI Head of Europe and Latin America Business Development Pedro Delgado speak at the 2012 Organización para la Excelencia en Salud health care conference in Cartagena, Baquero and his team were inspired to improve care, but weren’t sure how to improve patient outcomes while lowering costs and making care patient-centered.

After years of continuing to learn about the Triple Aim, Baquero and his team took on leadership of the hospital at the beginning of 2017. They recognized they had the opportunity to do things differently at their institution. As Baquero reflected, “Many of the families were happy with the care, but we wanted to go beyond that to let them know that they had support and a family inside the hospital.” Baquero and his team started using experience-based design so staff could partner with families and patients to develop better ways to provide care. (This included what is often referred to as empathy, emotion, or experience mapping and involves identifying what patients and their families feel when they use a service and when they feel it.)

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Some of the tools used to co-design people-driven change at Hospital Infantil Napoleon Franco Pareja included empathy mapping, one-on-one meetings with patient and clinicians and between front line staff and the clinicians and leadership during “coffee hours”. Storytelling and narratives are also used as a way to engage children in their healing process by allowing them to tell their story to clinicians, propelling a new bond between clinician and patient.

During co-designing people-driven change workshops, staff asked those who had the most at stake in the process — patients and families — what quality meant to them, starting with children above the age of six. Together, they mapped their health care journey to understand what quality looks like from their perspective, and what it would take for them to experience it in the hospital. This process is done quarterly as the staff learn to engage and adapt in action as they grow with their new methodology.

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Co-design workshops with families and staff.

The workshops helped staff and families create a new definition of what quality means:

  1. Manifestations of love — defined as the verbal and nonverbal language staff and clinicians use to manifest care
  2. Knowing how to treat the patient properly
  3. Moments of care and attention centered around the patient — defined as what children and their families experience when staff makes an effort to make their experience a positive and loving one

Many staff members described co-designing people-powered change in partnership with families and children as far more powerful and meaningful than designing care without them. Some staff members also realized that not all of them were fully equipped to deliver a humanized care experience.

After the workshop, Baquero and his team recognized that their staff needed tools on how to bring this new understanding about quality to life. They knew, of course, that they would always need further training on clinical protocols, but there was an immediate need to learn how to connect with patients and families through their common humanity. They also needed coaching on how to provide care that embodied this new understanding of quality. This led to the creation of a new, comprehensive leadership program. They now run this training four times a year with 45 staff members each time.

Baquero and his team have begun to change their organization’s culture by redistributing power, increasing joy, reducing costs, and improving the health of the populations they serve. While they still focus on the serious business of continuously improving the safety of care, they also recognize that part of what helps children heal is feeling like they’re kids and not just patients.

Santiago Nariño is an IHI project coordinator.

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