Global collaboration with the World Health Organisation to improve guidelines impact

As part of its charter, the World Health Organisation publishes a series of guidelines for all levels of healthcare and patient management based on scientific evidence. The aim is to promote informed decision-making to achieve the best possible health outcomes.

Some of its guidelines include those for malaria, prevention and diagnosis of rheumatic fever, standards and recommendations for treatment of burns victims in mass casualties, guidelines for influenza, and HIV testing services.

To understand the usability of guidelines in different countries, the WHO Product Design and Impact (PDI) Unit consulted with more than 70 end-users, including policy advisors, advocacy groups, patient representatives, and design experts. These interviews revealed that while WHO guidelines are trusted documents, there are multiple barriers to their implementation and uptake.

In a bid to address this, and enhance the design and usability of its documents, the organisation’s PDI Unit, in collaboration with Monash University’s Faculty of Art, Design, and Architecture (MADA), has developed a set of principles and tools that aim to improve use and impact of WHO guidelines.

Kidist Bartolomeos, the WHO PDI Unit lead, emphasised the importance of this collaboration, stating that:

“The Monash University co-design methods helped us to bring together guideline developers and users from countries and regions to understand the lived experience of using WHO guidelines. The WHO Principles and Tools contribute to the organisation’s effort to tailor guidelines to countries’ needs, and optimise the use and impact of WHO guidelines in countries.”

Key findings from the co-design process highlighted the multifaceted barriers to accessing and using WHO guidelines in public health initiatives at national, regional, and international levels. One of the major barriers identified is the limited consideration of the context in which a guideline will be used when determining the approach to dissemination, verbal and visual language, and content.

Guidelines are used by healthcare leaders to drive policy changes. Understanding the motivations of end-users is critical to successful implementation of a guideline.

What evolved from these consultations and series of workshops led by MADA was five core design principles to enhance the guidelines:

1. Design with empathy by understanding people and their context

Supports guideline developers in understanding the individuals and groups implementing a given guideline, and their unique circumstances and requirements for implementation.

2. Design for living guidelines

Supports WHO’s movement to incorporate emerging data and new peer-reviewed evidence for updating clinical and policy recommendations, allowing guidance to respond to changes in context. The necessity for guidelines to remain up-to-date and reflect emerging evidence was highlighted throughout the co-design process.

3. Design for accessibility

Recognises that WHO guidelines should be inclusive of all people who use them, and every effort should be made to eliminate barriers to access. The co-design process also reinforced that content included in WHO guidelines should be designed for easy access to readers, including policymakers seeking specific information to support health decision-making.

4. Design for clarity

Supports guideline developers in writing with clarity, maintaining a consistent structure, and being as concise as possible. This principle also encourages the presentation of content in a consolidated format so that end-users can quickly locate it and easily determine its relevance.

5. Design for translation to multiple languages

Recognises that WHO guidelines need to be written with translation in mind, considering the diversity of languages, cultural identities, and approaches to health and healthcare.

Leah Heiss, who is an associate professor and the Eva and Marc Besen International Research Chair in Design at Monash University, said the design tools would help put the principles into practice, and included various approaches to understanding end-user needs and challenges, such as a stakeholder network map, empathy map, enablers and barriers tool, and a guideline journey map.

“With this global launch, the WHO aims to close the gap between guideline developers and end-users, fostering better implementation and real-world impact of WHO guidelines worldwide,” she said.

The toolkit also incorporates specific communication design tools to support designers in laying out guidelines in formats that are easier to navigate, including an annotated sample guideline chapter, design guide, and a sample guideline page translated into the six official WHO languages.

This design project represents the collaborative approach that is part of the fabric at Monash Art, Design, and Architecture. The design team included Associate Professor Leah Heiss, Dr Myra Thiessen, Professor Gene Bawden, Dr Amy Killen, Dr Troy McGee, Hatoun Ibrahim, and Monash Adjunct Associate Professor Olga Kokshagina.