Single phrase description + impact: I led the end-to-end design and implementation of a new medical record system in a 500-bed hospital in Rwanda, that increased the quality of care and enabled to hospital to meet accreditations standards.

Type of project / project elements:

Service systems design

Instructional design

Equity-centered design

Capacity building

Steps: Inception to full implementation /evaluation

Client: CHUK / MOH

Date/duration: 18 months, 2015 - 2016

Problem to be solved + why important?: Medical record system was outdated: lost or incomplete data making patient care challenging, inconsistent documentation leading to inconsistent practices, time-consuming to document and retrieve data, did not meet requirements for accreditation.  —OR—   Decentralized piecemeal system - resulting in inefficiency and data loss, challenges with accreditation

Inconsistent practices - sub-optimized care provision.

Goals (match problem): EFFICIENCY - streamline healthcare service delivery; CARE QUALITY - prompt evidence-based care, manage data, get accredited; SUSTAINABILITY

Context: 500 bed hospital in resource-constrained (globally exploited/post-colonial) sett

Dealbreakers/constraints: it had to be used in all 21 inpatient departments, we had a year to complete it before the the next procurement, local ownership, limited: budget, time/personnel availably from hospital team, technology.

Resources: Desire for innovation at all org levels; Committed staff; Agile system

My role / team: Project manager, design lead, staff trainer

Brief description / steps of the process:

Needs assessment / current state / user research —

• Methodology choices?: participant observation, semi-structured interviews, focus groups / workshops

• Tools for synthesis or prototyping?: not much bc fast, also untrained, GANTT Chart with dependency mapping - project / launch plan; M+E with file audit.

Market research / landscape analysis?: COHSASA, HRH clinicians, MRS in other places

• Problem (discovered in research or prototyping): Free-write sections - inconsistent documentation, liable to omitted or irrelevant data - lead to challenges in continuity of care

• Insight/opportunity: forms could explain what was needed, and even prompt EBP!! And of course leap-frog preparation for accreditation

• Outlier/inspiration: anesthesia flowsheets were good, others not so much

• Solution: structure all sections with instructions on how to fill / what to do when possible

• Alternatives that were disregarded + rationale: to balance specificity with consistency- err on the side of consistency - no SO specialized for each dept. = most forms cross cutting, some w specialization.

• Problem (discovered in research or prototyping): Bound papers of general forms- any specialized or additional documents were free-floating, often misplaced, etc

• Insight/opportunity: in reality all files needed to be flexible

• Outlier/inspiration: best practices in other places

• Solution: binders

• Alternatives that were disregarded + rationale: hard decision bc pro and cons… thought about different bound notebooks for each dept, but with consults and transfers this wouldn’t work

• Description: #?? of cross-cutting forms, #?? specialty forms, binders. Weekend meeting with all admin to approve, pending funding.

Pilot/validation/refinement?: Scope pilot, decision based on testing in all areas, but also w committed dept leadership to make sure it would happen.

Implantation prep/management/colab: team of direct providers to become trainers, d and I train the trainers, get shelves, etc. Then final decision to fund itx

• quantitative: Increased score on audit for meeting requirements for COHSASA accrediation

• Qualitative: report that care is easier

• Unexpected challenges: needing selves etc on units

• I could have instead: done a more through assessment, prepared for this earlier

• Unexpected wins: how awesomely dedicated staff were,

• With more resources we could have: more staff training, or even EMR

• Next steps: continue to improve, plan to move to EMR

• Final take-home: ???.