My role on the team initially comprised design research with LHDs, identifying needs and constraints such that we could establish baseline requirements for the new system Once complete, I worked with team members to define the vaccination customer journey from start to finish, to design work and data flows, and to identify critical dependencies regarding data integration with appointment scheduling platforms. We created the new sign-up form with a backend development team, and provided virtual training to staff across the 35 districts. Just prior to launch, I designed the website where residents would access the form.
Data consolidation + statewide staff training
Process design
Rapid needs assessment
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Rapid needs assessment / design research: I was tasked with learning how the 35 Health Districts currently collected pre-registrations from their constituents, and how they used this information to schedule their vaccine clinics. With only 2 days to collect data and synthesize findings, I set up brief interviews with about 10 districts that varies in size and demographics, trunig to trying to s, selection of districts that chose a sample the processes only two days to collect and synthesize data, I set up brief interviews with a variety of
After the system went live, we continued to develop it with a weekly launch cycle for new features. I remained a liaison with the LHDs for training and troubleshooting, and created an end-user focus group with whom we co-designed and piloted improvements. The system remained in use until the vaccine supply was large enough that sing-up lists were no longer needed.
Critique & learnings
Weekly launch cycle: platform updates and moving to self-schedule
Go live!
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Website design
Website design from initial concept to completion
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I'm a generalist who can go deep on a few skill sets
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macro and micro
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strategy for success is combo of understanding what has happened to date in detail from multiple perspectives, and using this to frame an understanding of what might arise:
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anticipatory planning / strategy -- upstream effort ("delays") for downstream butter and amazingness (also constingency planning, when possible and necessary if risks, esp risk of harm exists!! ADD TO medical record project, also VDJ)
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data-driven decision making
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xxx
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Between 2012 -2018, the Rwandan Ministry of Health partnered with a consortium of 23 US academic institutions to increase the capacity of their healthcare education system, with the goals of growing the number of skilled clinical and administrative professionals and educators, and improving the system's infrastructure.
As a critical care nursing instructor in hired through the University of Maryland, I spent one year designing and piloting a training course for 21 nurses who worked in one of the country's four intensive care units (ICUs). The first of its kind and Rwanda, it was based on the curricular of existing courses but adapted to be successful per the constraints the context. At its completion, it was endorsed by the University of Rwanda and accepted to the International Forum on Quality and Safety that was held in London the following year.
ICU equipment had advanced rapidly, making it difficult to maintain up-to-date training.
The challange:
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Lagging training: The speed of technological advancement had exceeded that of continued professional development, resulting in varying and sometimes outdated patient care practices.
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Career limitations: Because professional certifications did not yet exist, nurses lacked a career ladder and therefore had little incentive to invest time time in continued training.
Context + constraints:
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One year timeframe, open format: I was contracted for 12 months, full time in the ICU, with little expectations on format and content.
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Local expertise: The program developed a structure of "twinning", wherein I was paired with a highly motivated nurse for the duration of the year, to collaboratively create improvements.
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Post-colonial context: Resource limitations existed that were typical of a post-colonial, globally exploited context.
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Staffing shortages: Per one of the reasons the program was created, there were longstanding national staffing shortages.
Project goals:
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Increase the knowledge and skills of the ICU nurses
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Improve patient care quality
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Expand professional opportunities
Process steps:​
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Needs assessment: While it was important to identify topics and content that might fulfil the project's goals, it was critical to understand what the staff desired, and what was feasible given time and space constraints.
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Landscape analysis: Because courses already existed for critical care nursing certification, it was far more efficient and effective to model a course from an existing curricula.
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Content creation: We collaboratively scoped the project and created a plan wherein I would create and teach 16 two-hour modules over the course of seven months. The major lift was creating slide decks for each module, that framed the classroom format of teaching, and that were designed to be a resource for future reference.
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Learning evaluation and M&E: To measure the efficacy of the project, I needed to create tools (exams) to establish baseline knowledge and measure improvements through the course.
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Seven months of teaching: Given scheduling limitations, in order for all nurses to attend the required 90% of the sessions, I taught each three times.
Solution & impact:
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Decentralized siloed process for VA residents to register for COVID-19 vaccine, resulting in vaccine delivery challenges and loss of public trust in state gov ;
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Lack of way that VDH can track who has received vaccine - for equity and also f/u care (#50th in state)
Wins, losses, learnings:
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Surprising win: xxxy
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Unexpected hurdle: xxx
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With more ______ we would have... xxx. ​
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Most valuable learning: xx
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Needs assessment
Nurses explained what they needed to learn
A survey helped determine learning needs
The first step was to learn about critical care nursing in Rwanda, and to understand what type of project would be most impactful.
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Participant observation
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Unstructured interviews
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Repeated surveys
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Landscape analysis
Research methodology
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Insights & problem-solving
We decided that a full scale certification course would be the best solution for the following reasons:
Physicians were readily available to help
Local context: Resource constraints made existing international certification courses not possible in the local context.
Challenge
Subject-matter experts: Experts from both Rwanda and abroad participated in determining best practices, and creating the course content.
Solution
Shared excitement: Collaboration among colleagues who didn't work closely together united previously siloed staff and galvanized enthusiasm about the course.
Impact
Classes took place in an unused ICU room
No guarantee of career advancement: Nurses would need to devote many hours each week to training, but the undertaking might not yield tangible value.
Challenge
National endorsement: We were able to secure endorsement from the University of Rwanda.
Solutions
Minimized time commitment: With support from the ICU medical director, we were able to hold the course in an extra room in the ICU, enabling nurses to attend it during their work hours.
Unified participation: Official backing from a high level institution provided incentivizing explicit value, and immediately accessible classes resulted in every ICU nurse deciding to take the course.
Impact
3
Final solution
A Critical Care Certification Course that spanned seven months, comprising 16 modules that were each approximately two hours long, and that I taught three times for scheduling accessibility.
Instructional methodologies & tools:
Learning assessments:
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Didactic classroom instruction
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On-the-job clinical training
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Case study group exercises
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Detailed slide decks and reference documents
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Preliminary comprehensive exam to establish baseline knowledge
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Pretest and posttest assessments for each module
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Midterm exam
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Final written and clinical exams
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Knowledge retention exam six months after course
Written and clinical exams were required for certification
Impact
4
Poster poster
Quantitative
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47% improvement: Final exam scores showed a 47% increase in knowledge about critical care nursing (median test scores).
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81% knowledge retention: Retention exam given six months after the course finished showed the nurses had retained 81%.
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Daily application: Also at six months, 95% of nurses reported that they they applied what they learned daily.
Qualitative
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Consistent practice improvement: Both ICU nurses and physicians shared that the department had implemented daily evidenced-based practices, including ventilator-acquired pneumonia prevention and scheduled patient turning.
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Boost in morale: The project was accepted to an international healthcare quality improvement conference in London, providing a boost in moral and sense of accomplishment. Many of the nurses said that the course "inspired them to be a better nurse".
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National training development: Based on its success, the Ministry of Health planned additional courses for other nursing specialties.
Our submission to the
International Forum on Quality & Safety in Healthcare in London.
Critique & learnings
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Unexpected challenges: xxx
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With more resources we could have: xxxR
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Retrospective concerns:
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Sustainanble??? (This plan also meant that I would need to teach each course 3 times to meet scheduling needs, and that classes would need to pause when a patient needed care. We made it work!)
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xxx​
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Final take-home:
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A collaborative, inquiry-Âbased approach to capacity building facilitates the identification of real needs, and creation of viable solutions.
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Unexpected win: Drastic improvement in one aspect (training) of a system (healthcare) produces both a demand & opportunity for parallel improvements, such that system growth is cohesive & can support sustained change: immediate need (& opportunity) to renovate medical record.
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Next steps: Given successes with this pilot project, the HRH Program is working to scale nursing specialization training to a national level. Both opportunities & questions abound regarding participants, trainers, certifying bodies, & continuing professional development recognition.
