How might we make postpartum patient education easier to understand and deliver?

In collaboration with UChicago Medicine Family Birthing Center

TEAM

Kim Erwin, Director, Equitable Healthcare Lab

Elizabeth Graff, MDes 2024

Sanjana Kumar, MDes 2025

SECTOR

Healthcare: Quality Improvement

DURATION

June 2024 – August 2024

ROLE

Design Research

Stakeholder Management

Project Management

Challenge

Poor quality discharge education is associated with more newborn Emergency Room and Urgent Care visits. But short hospital stays limit the time for clinicals staff to effectively address a new mother’s learning needs, especially given the large amount of mandated education required by various agencies. Patient satisfaction scores for the Family Birthing Center (FBC) suggested significant gaps in patient readiness to succeed at home after giving birth.

Citing a need to improve its patient discharge education, the FBC Quality Improvement team identified several aspects of patient education as needing attention. These include: refining patient education materials; establishing a consistent education process that begins at admission; improving and standardizing the quality of patient education provided by nurses; improving coordination & communication within care team members, & between care team members & patients.

Approach

Over nine weeks, we engaged 63 stakeholders including obstetricians, postpartum patients, nurses, midwives, pediatricians, lactation consultants, community health workers, social workers, patient care managers, and clinical educators.

We quickly learned that four different teams were collectively responsible for patient education, but they didn’t have a system for coordinating their teaching or for assessing patient comprehension.

As one pediatrician put it, “The right hand doesn’t know what the left hand is doing.” We learned that patients received different educational experiences due to factors unrelated to their needs such as which nurses happened to be assigned to their care, or when they happened to give birth in relation to other emergencies going on at the hospital. What patients learned was determined by chance, & as a result, patients were leaving the hospital feeling unprepared to care for themselves & their babies.

We engaged 63 stakeholders in 13 staff interviews, 14 card sorts to prioritize education topics, and 33 prototype tests [A/B testing]

Design Requirements

An integrated system of patient-facing and provider-facing supports including: a Patient Education Menu, an In-Room Education Whiteboard, and a suite of support materials for nurses and practitioners.

Screenshot 2024-09-24 at 11.54.42 AM.png

A sense-making development framework for patient education

We developed a framework to parse the challenge into three nested yet discrete layers: Content, Delivery and Coordination. We identified design requirements within each layer, such that patient education must have:

Content that is:

Organized and easy for patients to understand
Patient-paced so patient have an active role in their own learning
Consistent so that all patients are taught the same core topics

Delivery that is:

Scripted to support staff in providing consistent key messages
Timed to the middle of the hospital stay, rather than at day of discharge
Delivered with confidence to create better educational outcomes

Coordinated and visual so that:

All stakeholders can see the patient’s progress when they walk in the room
All stakeholders can track the patient’s self-assessed confidence with topics

Solutions

We identified and structured 36 topics that needed to be covered before a patient went home. We then prototyped solutions to address each framework component, but work together as a communication system:

A Patient Education “Menu” (Content)
Educational Pathways for each of the 36 topics that include key messages and a “hook” for engaging patients and a suite of implementation support tools (Delivery)
An in-room whiteboard with education topics, visible from the bed and the door (Coordination)

1. Patient Education Menu

All 36 educational topics are organized clearly and simply in the Patient Education Menu. Patients can choose and pace the sequence of topics as per their choice in that moment.

2. Educational Pathways & Suite of support tools for implementation

A ‘script book’ to standardize key talking points for each educational topic. To help staff adopt these standards, we developed a suite of delivery support tools:

The script book provides step-by-step guidance and scripting for nurses on how to effectively deliver the content associated with each topic on the Patient Education Menu.
Nurse break room posters model effective language to use when delivering care and are designed to be hung in the nurse break room.
Badge cards summarize the messages on the posters and can be quickly referenced at any point in time.
Role play teaching activities can be initiated by clinical educators with nurses during lulls in their shifts to give nurses practice and feedback on how they talk with patients.

3. In-patient Whiteboard

A templated whiteboard to visualize the patient’s learning progress. Content matches the patient education menu. Iterative testing and refinement ensures the readability and usability by all disciplines and the patient and family.

Reflection

Designing the sense-making framework: The nested "olive" model helped structure our staff interviews. When discussing specific issues, staff would often drift into related topics. By showing them our layered model - like an olive's pit, fruit, and skin - we could focus conversations while assuring them all topics would be covered in turn.
Prototyping through A/B Testing: We tested prototypes by presenting users with two versions, each designed for a different purpose. For example, we showed staff whiteboards that either tracked discharge progress or patient learning. Having users choose their preferred version helped us understand their needs and ultimately combine the best features into one final design.
Keeping count: In healthcare, tracking metrics was crucial. By reporting quantifiable data to stakeholders (like "6 out of 7 patients preferred Version A"), we built credibility and trust for our project.