Service Delivery, Service Design: A Closer Look at the Service in Health Design Project

Written by Andrea Fisher 

Service delivery is an area that South Africans struggle with daily and which affects the worse off the most. Public health care is one of these key challenging areas, which is why the Service Design in Health Project was so well received by its participants and stakeholders. The programme took multi-disciplinary teams through a co-design process led by Design Thinkers Group, to co-create solutions to improve service delivery and customer satisfaction at three city of cape town clinics. The clinics’ teams were empowered to raise issues, face challenges, co-create solutions and implement changes.

Trophies awarded ti participating Clinics

Trophies awarded ti participating Clinics

The idea was met with apprehension by staff members of the three clinics. Shaazia Fakier, Professional Nurse at Wallacdene Clinic says, “We assumed that it would be yet another project from which nothing much would come”. This doubt stems from previous experiences where these activities merely presented to them how their jobs should be done, without insight into the operation of the clinics. The teams were relieved to discover that it was exactly the opposite in this case. The Service Design in Health Project and all its collaborators were to implement small changes to improve the patient service experience within the clinics, with significant input from the clinics’ staff members.
The success of this initiative can be attributed to the enthusiasm from the staff who wanted to be heard and were eager to participate in journey-mapping; contributing their input and ideas, for a change. Clinical Medical Officer at Albow Gardens Clinic, Dianne Abrahams, expressed, “It was very refreshing having your voice heard and not have it be a top-down decision”. A platform was created for their thoughts and they realised that the clinics are theirs to improve; that this was an opportunity to help face the challenges in their place of work. Many expressed their delight in being given the opportunity to not just highlight some of the issues but to assist in creating solutions for change in their facilities. It was also important for the staff to make the decisions themselves, as they are the ones attending to the patients. Bongani Mani, Professional Nurse at Town II Clinic shared that “It created a platform for our thought processes. It made us think that we are not here just to work; we must make improvements in our workplace. The challenges that we meet every day, I must also make it better”.


Consul General Bonnie Horbach speaking at the Awards Ceremony

From the feedback of the project, it was deduced that a lot of focus was placed on changes towards a patient-centred approach. To achieve this, different changes were piloted and experimented with, before deciding whether it was worthwhile implementing. The teams learned a lot by “doing” and discovered that there is a lot that they can achieve with the existing resources in the clinics. In the words of one of the nurses, “you can bring changes; you can be the change”.
The changes that took place at the Wallacdene Clinic included improvements to the TB section and an improved baby changing area. Town II Clinic upgraded their signage to that which is more visually detailed, as well as established a private preparation area for children. A major issue patients visiting these clinics faced was the time they had to spend waiting to be attended to. The implementation of a new Arrival process now keeps patients well informed about waiting periods and the In-Out Board has opened the communication between staff members and with regards to daily staff presence.

The teams agreed that once action began to take place, the attitudes of all the staff began to change. Regarding this, William Dicks of Albow Gardens Clinic said, “When they began the building of the Counsellor’s Room, everybody had energy; I see people act differently towards the patient; they’re more motivated”. Now that they knew they were being noticed and no longer working in isolation, according to Acting Senior Therapist, Zakia Arend, the staff were in greater spirits and more determined to face whichever challenges faced them. “They have opened up to a new way of thinking and have expressed that they are confident that they are providing a full, satisfying service to their patients, in peace and privacy”, said Arend.


#cocreateSA Service in Health Design Project Participants and Organizers

The respective teams acknowledge that once the project is complete, they will continue to reap the benefits thereof and use their newly-acquired skills. There is also a confidence within them to face future challenges as a team and develop solutions together. The recommendations from this project will be presented to the Health Directorate and direct project stakeholders, including the Dutch Consul General, at a workshop to be held in August 2017. These recommendations will kick-start a strategic conversation to inform of the formulation of a roadmap for the roll out of Service Design (or aspects thereof) as a core competence in the City Health Directorate. With the enthusiasm and positive attitudes of those already involved in the project, along with the favourable changes which have been implemented thus far, this project will impact health care service delivery remarkably.

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