Supporting the implementation of a Maternal Early Warning System (MEWS) protocol using Human-Centred Design

Maternal Early Warning System (MEWS) protocols enable a systematic and standardized approach to medical emergencies in pregnancy. Such protocols have been associated with a decrease in severe maternal morbidity and related inequities. However, MEWS protocols are complex to implement. We adopted a Human-centred design (HCD) approach to support the implementation of a MEWS protocol at a tertiary care centre. In Phase I (Discover), we aimed to understand the needs, challenges, and desires of clinicians, as well as persons with lived experience (PWLE) of pregnancy and support people, in order to identify gaps in care and generate ideas for potential solutions. In Phase II (Design), we validated findings, co-created sustainable solutions to be tested, and engaged in collaborative work to shape the future implementation. In Phase III (Prepare), we equipped the clinical team with resources for upcoming implementation. Across these phases, we organized 10 interactive activities (including semi-structured interviews, an asynchronous activity, and online/in-person group sessions) with clinicians and PWLE of pregnancy and support people. An Advisory Sharing Circle, focusing on health equity and inclusivity, shared insights and provided feedback that was integrated throughout the project. In total, 38 clinicians and 8 PWLE and support people participated in planned activities. We identified several care gaps that would need to be addressed to optimize implementation of the MEWS protocol, including opportunities to improve communications, documentation, and collaboration. PWLE and support people wanted to be empowered with information, participate in specific tasks, and have more agency in their care. We co-developed solutions to facilitate upcoming implementation, including a mechanism for patient-led activation of the MEWS protocol, and visual resources to encourage patients and support people to share any concerns. We also created a quick reference guide with action and education items to prepare the clinical team. Using HCD, we successfully engaged with knowledge users, including clinicians, PWLE, and support people, to plan the implementation a MEWS protocol into clinical care. This novel approach, fostering a justice framework, has the potential to reduce the knowledge-to-action gap and enhance sustainability by co-developing solutions with those directly impacted by the problem and change.