Health workers across health systems and disciplines face several significant, intersecting stressors and burdens. This is especially the case for those who work on the front lines during public health emergencies and those who work in impoverished and low-resource settings or settings where stigmatization is high.
Safety issues compound these challenges. Healthcare workers are four times more likely than other professionals to be assaulted, with those most at risk including junior doctors and nurses and those working in government hospitals, emergency departments and intensive-care units. These issues have contributed to a global shortage of health workers, which has economic and health consequences for health systems and economies.
In addition to lacking peer, organizational or professional support to help them manage these stressors, health workers, especially in developing countries, also lack access to basic, practical and up-to-date information to enable them to deliver safe, effective care.
To meet these dual challenges, Reach Digital Health (previously Praekelt.org) launched the HealthWorkerConnect (HWC) platform in mid-2020, at the peak of the COVID-19 pandemic in South Africa. Supported by Johnson & Johnson Foundation, HWC became a valuable tool for the South African National Department of Health, enabling the rapid distribution of verified COVID-19 information and support for primary healthcare workers as the pandemic unfolded.
HWC also ‘cares for the carers’ by providing healthcare workers with information that addresses burnout and stress. Today, the platform reaches over 5,000 healthcare professionals across South Africa.
It has also served as the foundation for building the healthcare worker-facing intervention on WHO HealthAlert, a chatbot set up as part of the World Health Organization’s COVID-19 response targeted to a global audience. Based on the learnings from HWC, WHO HealthAlert’s now expanded platform, WHO HWC, empowers healthcare workers worldwide with targeted skills-building resources as well as psychosocial support.
Applying a systems thinking approach to developing technology
“While Reach built HWC as part of the COVID-19 response, the rapid prototyping and testing provided early learnings that reinforced the importance of a systems approach to developing technology that strengthens the core infrastructure of health systems,” says Debbie Rogers, CEO at Reach Digital Health. “WHO HWC applies information and tools to drive behavior change and strengthen health systems through improving confidence, competency and psychosocial reports for health workers enrolled on the WHO HealthAlert platform. It is technology that is helping to strengthen health systems for routine primary healthcare services while also building a solid platform for emergency response.”
To achieve this, WHO HWC focuses on two things:
- Improving knowledge and skills development on basic health and public health topics and;
- Improving resilience among health workers by addressing burnout and building skills to manage stress and boost confidence and well-being.
Before expanding the HWC platform to health workers on WHO HealthAlert, the Reach team conducted significant research to understand health workers’ specific needs. They worked with South African-based HealthWorkerConnect insights to determine the most prevalent health worker challenges on a global scale. In parallel, they sought to improve the challenges of scaling the HWC South Africa platform, including high drop-off rates and low user retention.
Risk-scoring assessments built into the platform help determine those health workers at high risk of burnout or not providing high-quality care to patients. Reach then targets these users with customized interventions, such as user segmentation and content tailoring, to help healthcare workers boost knowledge-building and resilience.
“This approach has enabled us to improve the targeting of digital interventions so that users receive the right information on current, globally relevant health topics and the right interventions, including stress management tips and programs, and knowledge-building courses, at the right time,” explains Rogers. “Additionally, by providing bespoke information, we will improve healthcare workers' overall effectiveness and retention on WHO HealthAlert.”
Tailoring learning journeys for time-constrained health workers
WHO HWC shares information from trusted sources, including the World Health Organization (WHO), Ovid, the National Library of Medicine and JAMA Network, via:
- Targeted alerts, including guidance on natural and manmade disasters
- Self-help tools on topics including resilience
- Resources to enable health workers to access relevant information quickly
Reach has supported various learning techniques by offering this diverse content in various formats, including using rich media types such as images, videos, audio (voice notes), checklists and quizzes. WHO HWC is designed to keep users engaged and promotes continuous learning in ways that provide health workers with quick access to the information they need. For example, “Ask A Question” enables users to search and find the information they need most urgently, rather than manually navigating menus of information. Other features like push notifications deliver real-time guidance and updates from WHO, and reminders are sent to help users keep track of learning progress and course completions.
Reach also intends to integrate feedback mechanisms throughout the intervention to empower users to customize their user journey according to their preferred learning style. Segmentation pathways and surveys will monitor changes in knowledge and resilience scores across different cadres, alongside the average quality of care, average medication errors and average presenteeism. Defining a strong measurement and evaluation approach early in the design stage will allow the Reach Digital Health team to explore the complex relationship between quality of care and emotional exhaustion and ultimately help to optimize health workforce solutions.
“Systems thinking is at the heart of the Johnson & Johnson Center for Health Worker Innovation’s approach to closing the healthcare gap and building a thriving health workforce,” says Sarah Mullane, Director, Health Technology at Johnson & Johnson. “By applying systems thinking in the health sector and underpinning it with a strong measurement and evaluation strategy, we can accelerate a more realistic understanding of what works, for whom, and under what circumstances, and thereby move towards real, lasting transformation.”