1. Building Quality Systems for Scale
Nick Pearson

2. Jacaranda’s approach
(1) We design better systems for delivering quality maternity care,
(2) test and prove them in our own centers of excellence,
(3) and then work with the government and private sector to replicate in the hospitals where most babies are born.
Designing and delivering high-quality, cheap, respectful facility-based care – with solutions that address the key drivers of quality.

3. Jacaranda’s approach to improving Quality
QUALITY GAP
Hospital systems and processes
Nurse/midwife capacity and knowledge
Respectful care
OUR
SOLUTION
Clinical excellence and Quality Improvement
Empowering the next generation of midwives
Patient centered design
TOOLS FOR SCALE
Lean six sigma
Evidence based clinical protocols and checklists
Better technology/measurement
Onboarding / orientation
Mentorship and training
Career ladder and specialization
Design of services / touchpoints
SMS interaction with clients
We design and test these tools in our facilities and then work to scale the most replicable ones through partners.

4. Nurse/midwife capacity and knowledge

6. Hospital systems and processes

8. Spaghetti Diagram of Outpatient Flow: Prior State
Reception
Pharmacy
Lab
Exam Room1
Exam Room 2
Medical Records
Client comes to reception
Return with file to enter client records
Send client to exam rooms 1 2 3
Send client for lab tests
Client return to exam room
Check drug availability & pricing
Client confirm if can afford drugs
Nurse dispenses drugs
Client exits 4
Pay bill 10 5 6 7 8 9

9. Spaghetti Diagram of Outpatient Flow: Current State
Cashier
Pharmacy
Lab
Exam Room1
Exam Room 2
Medical Records
Clients pulled into exam rooms
Go to Lab for tests
Client collects drugs from Pharmacy 1
Reception 2 4 5 3
Pay bill

10. measurement
Implementation science: now that the maternal health community knows what maternal health interventions work, we need to measure how to implement them at scale.
Systems for monitoring and evaluation
Research

11. Patient respect / patient-centered care

12. Our theory of Change 1. Jacaranda Maternities
2. Replicate at partner hospitals
3. Scale what works
DESIGN BETTER SYSTEMS
ADAPT THE BEST INNOVATIONS
TOOLS to TEST
TOOLS to SCALE
BUILD PARTNERSHIPS
TEST WITH PATIENTS / NURSES
TEST WITH PILOT PARTNERS
ITERATE AND IMPROVE
ITERATE AND IMPROVE
BUILD CAPACITY/PARTNERS TO ROLL OUT
MEASURE IMPACT / COST
MEASURE IMPACT / COST
Lean six sigma
Nurse leadership
SMS/FP interventions

13. Our theory of Change: A. Our maternities
Jacaranda Maternities
Success to date
Class-leading health outcomes
Increasing sustainability of our facilities
Demonstrated effectiveness as an “innovation laboratory” for implementation research
DESIGN BETTER SYSTEMS
PILOT
PACKAGE
TEST WITH PATIENTS / NURSES
ITERATE AND IMPROVE
MEASURE IMPACT / COST
Lean six sigma
Nurse leadership
SMS/FP interventions

14. OUR Maternity results: health outcomes and behaviors

15. OUR Maternity results: health outcomes and behaviors
One of 7 SafeCare level 3 hospitals in Kenya
Home-based postnatal CHW checklist = mothers 80% more likely to visit healthcare facilities after birth
100% early initiation of breastfeeding. Over 90% still exclusively breastfeeding at 9-week postpartum – nearly 3x the national average.
97% of our clients would recommend us to a family member or friend.
Postpartum family planning uptake 56% = 6x higher than the national average. Over 60% of Jacaranda’s clients choose long-term methods.
Over 60% of women who receive reminder messages return for visits
78% return for maternal or infant postpartum care in the first six weeks.
Increasing conversion from ANC to Delivery – 2x increase in the last year to over 50%
PRENATAL
CHILDBIRTH
POSTNATAL
POSTPARTUM FP

16. Improving sustainability and cost-effectiveness
Earned revenue up 6x since a year ago.
2nd clinic 50% breakeven in June.
Improved client conversion in retention and delivery – nearly 50% of ANC clients deliver, up from 25% in 2014
Cost per high-quality delivery = <9,000 KES

17. Our theory of Change 1. Jacaranda Maternities
2. Replicate at partner hospitals
3. Scale what works
DESIGN BETTER SYSTEMS
ADAPT THE BEST INNOVATIONS
TOOLS to TEST
TOOLS to SCALE
BUILD PARTNERSHIPS
TEST WITH PATIENTS / NURSES
TEST WITH PILOT PARTNERS
BUILD CAPACITY/PARTNERS TO ROLL OUT
ITERATE AND IMPROVE
ITERATE AND IMPROVE
MEASURE IMPACT / COST
MEASURE IMPACT / COST
Lean six sigma
Nurse leadership
SMS/FP interventions

18. Our theory of Change: B. Partner hospitals
Replicate at partner hospitals
Success to date
Kiambu County Partnership
Piloting in 3 facilities, doing over 200 deliveries/month
Rolled out lean QI engagement.
Plan to test our other low-cost innovations through these partners – SMS outreach, nurse training, etc.
ADAPT THE BEST INNOVATIONS
TOOLS to TEST
TOOLS to SCALE
TEST WITH PILOT PARTNERS
ITERATE AND IMPROVE
MEASURE IMPACT / COST
Lean six sigma
Nurse leadership
SMS/FP interventions

19. What we are excited about
Helping support and execute the framework provided by KQMH
Building leadership and community in quality improvement in the facility landscape.
Working with other partners to replicate our innovations.