Designing for Complex Systems: Uplifting Healthcare for The Nation
A talk by Dave Airel Benson Mangindaan at Somia Conference Systems Thinking in Design on 8 Nov 2023 by Somia CX.
To continue from our compiled key takeaways from all our speakers in our event last Nov 2023. Here’s a more detailed sharing of our fifth speaker, Dave Airel Benson Mangindaan.
Dave began his talk by introducing the team of researchers and designers involved in the Digital Transformation Office (DTO) of the Ministry of Health (Kementerian Kesehatan Republik Indonesia). To realize their goal of uplifting healthcare for the nation, the team often visits Indonesian regions to observe how digital services and healthcare services are provided to the communities.
One of their recent endeavors includes their visit to Puskesmas Siso in Soe, a small town in Nusa Tenggara Timur.
Using this visual, Dave introduced one of the bidan (midwives) and explained her role in the region. In villages, midwives are often attached to the local Puskesmas (Pusat Kesehatan Masyarakat: the government-mandated community health centers located across Indonesia).
Although these midwives typically work in the Puskesmas, they also conduct home visits and contribute to Posyandu (Pos Pelayanan Keluarga Berencana — Kesehatan Terpadu, which is a communal place that provides essential health services for mothers and children in rural areas) by delivering healthcare services every month.
Often, communities in rural areas are afraid to visit the Puskesmas, so Posyandus ensure they still have access to necessary healthcare services.
Dave observed that the midwives found visiting the Posyandu a delightful task; they were willing to handle the children daily and spared no effort in ensuring their health.
When asked, a midwife explained that her passion for her work was the reason she enjoyed it. However, she could not say the same for administrative work.
Further conversation revealed that the bulk of the midwife’s schedule was repetitive and redundant administrative work.
From 8 AM to 11 AM, the midwife distributes healthcare services. From 12 PM to 4 PM, it’s just administrative work.
Her frustration mainly stemmed from having to do administrative work using many different applications. Because the systems were developed by different divisions, the same information (e.g., growth monitoring information such as weight, height, etc.) had to be inputted twice into two different applications.
She’s not the only one with this problem — in fact, this struggle is shared throughout the healthcare field.
Inspired by this obstacle, the team at DTO delved into further research. They came to the conclusion that their hardships resulted from a bad habit: every time there’s a problem, a new application is built to solve it in a specific manner, without considering other applications. Typically, there is a lack of ecosystem point of view.
The consequence of this habit is that the collective effort, resources, and money of a region are poured into separate, disconnected systems when they could have been combined to make the bigger picture: a single, efficient healthcare service ecosystem.
This is the current state of healthcare apps in Indonesia: short, specific apps that serve a specific, linear solution to a problem. They are akin to disconnected parts of a system.
Dave went on to declare the challenge: How might we connect the dots of these multiple, disconnected ideas of apps; combine them to make them circular; arrange them to compose the ecosystem of an efficient healthcare administrative process?
Dave and his team’s principle in approaching these multiple, specific apps is to promote excellent healthcare services that ease administration through digitalization and integration.
Based on this principle, Dave and his team set out to orchestrate the ecosystem in multiple steps.
1. Mapping nearly 400 Healthcare apps
Dave substantiated his claim on the disconnectedness of Indonesia’s healthcare system by revealing that there are nearly 400 healthcare applications in Indonesia that are disconnected and linear.
To start their journey, Dave’s team set out and researched all these applications to map out their owners, the goals of the apps, the features of the applications, and their status (i.e. whether they were still running, whether they were well-used, the status of their functionality, what apps were already there, etc.).
2. Identify the separate systems’ goals and functions
Dave illustrated this step using a simplified example of the mapping of the division of health and nutrition for mother and child.
In this scenario, the goal is to monitor the growth of the child through Posyandu. To build efficiency, Dave’s team mapped the workflow and simplified it into the following processes: the registration, measurement, and counseling.
Using this mapping and the aforementioned apps accounted from before, Dave and his team identified which systems fulfill what step in the workflow.
This practice can then be scaled up for other purposes, like disease screening and immunization. This system mapping helps identify which stages have multiple apps, which stages have overlapping apps, and which stages have a gap in them.
3. Co-design
After acknowledging the information discovered through the mapping and identification process, Dave and his team moved on to the co-design practice.
The co-design practice process helped them figure out what systems to connect and how to configure the systems to integrate so they can expand their functionality.
4. Micro-pilot
The last step in their approach was to fill the gaps in the stages identified from the mapping. Through the co-design process, the team figured out how to fill the gap by merging systems or building new apps. Regardless, both need to proceed through the micro-pilots.
After the development of the systems, micro-pilots were held through roleplay or testing in their intended environments.
Based on the four steps of the approach, Dave highlighted two solutions to create the healthcare service ecosystem.
1. Standard
Create standards for the systems so different applications can connect and work together. For example, in the division of monitoring child growth, one system can be tasked to monitor three variables, while the other monitors five. It is the job of the Ministry of Health to make the standards for these apps.
Firstly, through co-design and workshops, the team at DTO invented the standard through SATUSEHAT. It standardizes healthcare services by ensuring whoever creates a system can follow the instructions from the standard to integrate and connect with other systems.
Secondly, the team crafted an onboarding page. They’ve encouraged Puskesmas, hospitals, and other private systems to connect with the standard SATUSEHAT. Adopting the standard facilitates system integration, thereby enabling seamless data sharing across all systems.
2. Tools
Dave and his team also developed tools in consideration of the gaps in the mapped workflow. The built application, Sehat Indonesiaku can be used by stakeholders who don’t have an app or digitalization support, they can use our app. It’s also integrated into the standard, SATUSEHAT.
The digital transformation of the Ministry of Health has been an ongoing project for around a year. The fruit of their efforts thus far is that approximately 10,200 Puskesmas have been integrated with the standard SATUSEHAT and utilize the connected systems in the ecosystem.
Additionally, because of these standards and tools, almost 125,000,000 immunization data have been collected.
Immunization is specified because it was the first module the DTO built. Dave declared that there will be more standard modules to come alongside the systems and their integration.
DTO’s next step is to:
- Continue promoting the standard SATUSEHAT.
- Expand the functionality of their tools.
While acknowledging “a long road ahead for integration”, Dave remained optimistic, stating, “we’re still going strong.”
DTO’s dedication is to use digitization and integration to bring healthcare services everywhere in the nation.
More articles about the conference coming soon, so don’t miss any by following Somia CX Medium!
Read more articles on Systems Thinking from the Somia Team here:
- Systems Thinking in Design: What is it? — Part 1
- Systems Thinking in Design: Why is it important? — Part 2
- A Framework to Embed Systems Thinking into Design Thinking Process
- Systems Mapping Tools & Design Levers
- Systems Thinking in Design: Shifting Our Mindset
- Systems Thinking in Design: Systems Innovation
I’m Kimora, an intern at Somia CX. I’ll be publishing more articles soon; you’ll be able to read here! I’m also on LinkedIn. 😄
