Co-Designing a Digital Caseload Tracker

Aim

To develop through co-design a user-friendly, midwife-centric digital tool for efficient caseload management, that facilitates collaboration, and reduces handover time and administrative tasks.

Outcomes

During a 6-month period, the caseload tracker app was utilized by 1028 mother-baby dyads, demonstrating its widespread acceptance. All 51 midwives actively participated in the program, resulting in 100% user engagement. The app successfully recorded 5400 instances of service and captured 1200 birthsuite hours and indications. The previous manual process of logging service occasions in a spreadsheet was replaced by a simple click of a button per event, significantly reducing data entry errors. Additionally, the app replaced an additional spreadsheet used for logging birthsuite hours, with 1206 events now being logged through the app.

Within two months, all 45 midwives had adopted the app. This digital solution drastically improved caseload management efficiency, providing crucial handover information and enabling personalized advice for any woman under MGP care, even at 2am.

Background

The Midwifery Group Practice (MGP) model necessitates efficient caseload tracking, particularly during off-hours and fatigue breaks. Midwives need to know or be able to rapidly retrieve all the key information regarding families in their caseload, including birth plans, complexities and which members of the Multi Disciplinary Team (MDT) are involved in their care 24/7. In addition, they need to be able to respond to calls from women in a colleague's caseload and provide individualised advice based on the woman's unique history and birth preferences. Midwives also required to manually log every phone call and visit for funding purposes. Existing solutions proved costly and lacked data sovereignty, highlighting a need for a bespoke, cost-effective solution.

MGP midwives are a community based workforce requiring access to tools and electronic systems to support their work; without these tools there are information privacy or data security concerns. We identified this vulnerability and recommended the need for a secure, accessible system. Benchmarking with other maternity services offering 24/7 on call midwifery models of care revealed similar challenges nationwide.

Methods

Involving over 30 midwives, four midwifery leaders, and the IT team, we used the Microsoft Power Platform to create a user-friendly tool that replaced outdated methods like diaries and spreadsheets. This app provides secure access, real-time editing, and activity reporting of caseload information, all at the midwives' fingertips.

The digital solution relied on a SharePoint list to store mother and baby dyad details securely in a locked channel of a Private Microsoft Teams. A Power app was developed for midwives to access and update the information. Another list was created for activity logging and billing management. Power Automate was used to make necessary changes in either list, such as updating the baby's age or logging service occasions.  A Teams chat group and regular face to face discussions during education sessions/team meetings were used to gain rapid user feedback to inform the next iterations of the system.  Two MGP teams volunteered to be the initial pilot groups, with roll out to all nine teams, two months later.

Remarkably, this project was developed at zero cost by a midwife for midwives, with invaluable support from the IT team via a citizen developer approach. We demonstrated that midwives can be actively involved in creating innovative software solutions, incorporate end-user perspectives, and overcome funding roadblocks.

Discussion

The evaluation of the MGP Caseload Tracker app involved various methods to gather feedback and assess its effectiveness. Rapid user feedback was obtained through a Teams chat group and regular face-to-face discussions during education sessions and team meetings. This feedback was crucial in informing subsequent iterations of the system.

The primary form of evaluation focused on the adoption of the Caseload Tracker by the team, accompanied by ongoing verbal and written feedback. A co-design approach was employed, involving multiple Plan-Do-Study-Act (PDSA) cycles. This iterative process allowed for continuous improvement based on the feedback received.

A key aspect of the evaluation was actively soliciting the team's input on frustrations and barriers to the app's use. This proactive approach ensured that the development team could address these issues promptly, fostering engagement and usage.
To supplement the qualitative feedback, data regarding the usage of the tracker over time was monitored. This information served as a prompt for further verbal and written feedback, helping to identify areas for improvement and gauge the app's effectiveness.

Overall, the evaluation process employed a combination of rapid user feedback, ongoing dialogue, and data monitoring to continuously enhance the MGP Caseload Tracker App and ensure its successful integration into clinical practice.

The app received positive feedback from midwives who expressed their satisfaction and provided suggestions to the developer, manager, and director. The team also requested planning sessions to enhance the system, aiming to optimize tasks such as mileage logging, reminder texts, and caseload allocation.