Journey Map (Maternal Health) Touchpoint key

Patient personas Optional touchpoint Off-island touchpoint

An illustrative current-state experience of the end-to-end First 1,000 Days Pathway, from the perspective of the four personas to bring it to life*
PHASE
Discovery of the pregnancy Pregnancy (First Trimester) Pregnancy (Second Trimester) Pregnancy (Third Trimester) Post-partum

Angela 32-year-old first time mother who is Specialist care Diagnostics Scan/Ultrasound Specialist care Specialist care Diagnostics Specialist care Other Overseas care Specialist care Birthing Follow-up care
Specialist care
three months pregnant and works full-
time as a legal secretary
Wants, needs, behaviours:
TOUCHPOINT 1.0 1.1 1.2 1.3 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 5.0 5.1 5.2 5.3 5.4 5.5 5.6

• Wants to be able to understand the I learn I’m pregnant I attend an I obtain a I book an I attend my first I receive I am referred I visit a I am referred for a I have an a I am referred I have a I see my I get a referral I see an I visit my I get information I visit my I am referred for I have an I visit my I register with I attend I visit my I see an I visit my I get a I visit my The SH&R I visit my I delivery my My baby is My The SH&R I visit my OB for I visit my OB I go into I phone/email my I go to the I give birth at A paediatrician I get A health visitor A health visitor I take my I attend a A health visitor I
and want to confirm appointment referral/I refer appointment with OB/clinic information for bloodwork lab/hospital/clinic dating scan dating scan for a nuchal nuchal OB/clinic to to specialist specialist to OB/clinic for a about OB/clinic for a an anatomy anatomy scan OB/clinic for a a antenatal & OB/clinic for a specialist to OB/clinic for referral to OB/clinic for a clinic refers OB/clinic for baby flown premmie clinic refers a monitoring for a labour OB to advise I’m hospital to home performs a discharged calls me to visits me and baby for a postpartum visits me and
care she and her baby will receive my pregnancy with with my GP to myself to an an appointment about how to for my bloodwork translucency translucency discuss my care (i.e. manage my monitoring registering for monitoring scan monitoring paediatrician breastfeeding monitoring manage my a monitoring early monitoring to an OB a monitoring prematurely overseas baby to an OB appointment monitoring in labour give birth new born home arrange a first my baby at newborn check-up my baby at
care for myself endocrinologist) appointment condition appointment
a healthcare confirm my OBGYN/S&RH OBGYN/S&RH scan scan lab and scan condition appointment antenatal & appointment appointment classes intervention appointment (28 weeks) appointment for receives (36 weeks) appointment exam at the home visit home hearing test with my OB home
during
• Empathetic and personalized provider pregnancy clinic clinic during
pregnancy
results during
pregnancy
breastfeeding
classes
pregnancy
for my baby premature
care
care
overseas
hospital/office

communication showing that her

medical team truly cares
• Initially nervous about what to In person
expect from her pregnancy and
1.2
1.1 1.1 1.1 1.1 1.1 1.2 1.1 1.2 1.1 1.1 1.2 1.1 1.2 1.1 1.1 1.1

(setting)
birthing journey In person 1.2 1.2 1.1 1.2 1.1 1.1 1.1 1.1 1.2 1.1 1.2 1.1 1.2 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.1

(self)

CHANNELS
Private Basic Health Coverage In person 1.2 1.2 1.1 1.2 1.1 1.2

(home)

Phone 1.2 1.2 1.1 1.2 1.1 1.1 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.2 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.1 1.1 1.2

Vanessa 20-year-old first time mother who just

found out she is 4 months pregnant. She @ Email 1.2 1.2 1.1 1.1 1.1 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.2 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.1 1.1 1.2

is unemployed and wants to start college

next year
Wants, needs and behaviours:
• Lacks a social support network – she
lives with her parents who work full-
time
• Worried about not able to afford care
for herself and her baby
• Compassionate care and support to
address her other needs (i.e. financial)
• Rarely visits the doctor and her
medical records are limited.
GAIN POINTS
The positive experiences
which enhance the journey
and exceed patient and staff
expectations
Self referrals to OBGYN/SH&R are Expectant mothers have access to Diagnostics imaging and scans Mother and baby’s health continues to The private setting provides
made upon discovery of pregnancy. specialist care through their OB/clinic. As pregnant women enter their third There is a care pathway for premature born Women welcome the support they receive from
follow global clinical guidelines. be routinely monitored with any access to antenatal/pre-natal All women will have access to specialist care
trimester they will visit their OB/Clinic more babies at various stages of prematurity. Usually, their health visitors and home visit post-partum.
Support for uninsured citizens: The necessary specialist referrals done when classes from an OBGYN during their third trimester.
often, which provides a good level of if born under 26 weeks, premature babies are During this visit, the child health record book is
S&RH clinic provides antenatal care to Diagnostics and screening services OB/Clinic provide information to women needed provided to mothers alongside general screening
A breastfeeding class has reassurance of being adequately cared for. referred overseas for further care. In addition,
women at no cost, particularly for the are provided to expectant mothers in about nutrition and how to care for their and health assessments
Women receive information about recently been restarted by the established relationships are in place with
uninsured. adherence to global clinical guidelines health during pregnancy. Women that receive care at the public clinic
antenatal and breastfeeding classes public clinic Early intervention referrals can also be overseas providers such as Boston Children
Primary care support: GPs make are referred to an OBGYN for a 28 and 36 Women are able to attend a postpartum check
Diagnostics and screening services Mother and baby’s health is routinely Women are advised to made by providers at this stage of the Hospital and the Sick Kids Hospital in Canada. with their OBGYN usually at 6 weeks postpartum.
referrals to specialist care and An established community of doulas weeks appointment and preparation for birth..
for antenatal care are available on monitored. The number of antenatal register with a pediatrician pathway with families needing accessing Women receive information about their
diagnostics services. They also provide island through a network of labs, exist to support mothers through their
appointments a woman attends is and receive some information to early intervention getting education on birth pathway from their OBGYN in
information to women regarding sexual pregnancy and birthing journey
clinics and the hospital guided by their health needs about newborn screening services available. preparation for it.
and reproductive health

No insurance EMOTIONAL JOURNEY

An illustrative scale from -3 to
the citizens’ emotional journey
Laura 32-year-old reinsurance underwriter with
who recently relocated to Bermuda from
the USA
Wants, needs and behaviours:
• Has only experienced a midwife led
care pathway for her first pregnancy
• Prefers an out-of-hospital birth
• Trust in the team of doctors, nurses,
and staff that she is in the right care
and that her choices are respected
• Would like the support of a doula
Major Health Coverage
James is 34 and Natasha is 29 years
James &
old. Natasha just gave birth to baby
Natasha Lucas, who was born premature at 30
weeks and flown overseas for his care
OPPORTUNITY AREAS
Wants, needs and behaviours:
• Compassionate care as they
impact on patient experience
struggle with knowing how to care
for their premmie baby
• Worried about services available on
island and long-waiting list to
access early intervention services
• They’d like to connect with other
families like them
+3 to track the movements in
across the touchpoints
PAIN POINTS
The negative experiences
where the system is not
meeting expectations from
the perspective of both
citizens and staff
High-level identification of
the core opportunity areas
that would have the greatest
Information about what to expect from Care transitions from the public clinics to an Women who give birth at the hospital feel
Unclear on services available: Whilst antenatal care provided by As women move along the Access to paediatrician Women that do not register with a Women believe their postpartum follow-up care
uninsured women are not always pregnancy can be limited: with some the public clinics at no cost, pathway, and where they continue OBGYN at 28 and 36 weeks during their that more could be done around raising paediatrician ahead of birthing will be with their OBGYN is limited with not sufficient time
variation: some women/families
aware of services available to them women experiencing feelings of medications are not covered which in to see an specialist for some of their will be offered an in-person visit
pregnancy. This is perceived as impacting standards of care, specially post-partum. visited by an on-call paediatrician for dedicated to emotional wellbeing checks.
through the public clinics. In some uncertainty, questions about what care some individual cases poses an care, lack of coordination of care, continuity of care. their newborn screening assessment.
with a pediatrician when Families and partners that accompany
cases this leads to late presentation they’ll receive and needing guidance about additional cost burden on women. and medical records not shared
registering whilst other won’t. Patients that transfer care from the public women during their birthing experience do not Mental health and wellbeing checks performed by
of pregnancies, with limited or no how to manage existing conditions. between providers can cause
Historically, the public clinics carry clinics to an OBGYN worry about cost of care always feel sufficiently informed about clinical health visitors are considered a ‘checklist exercise’ and
provision of antenatal care. unnecessary stress, Access to antenatal/prenatal and not being able to pay for OBGYN not focus on understanding the needs of the patient.
OB care experienced by patients vary some stigma associated with the interventions (i.e. C sections).
Women who are underinsured may classes for the uninsured appointments, which sometimes results in
from one provider to another: this is services they offered (i.e. STD testing) provided at no cost is limited.
Patient confidentiality issues have limited access to specialist failure to attend the referral. Emotional wellbeing support for women who
reflected in how people access which may deter access to services
deters some women from care, which puts a strain on physical experience stillbirth is very limited with patient
information like results from bloodwork or but some segments of the population. Women that give birth prematurely and whose
accessing essential maternal and emotional wellbeing Patient confidentiality remains reporting ‘out of touch’ behaviors from clinical
scans, or in the way they communicate babies are flown overseas experience emotional
services for fear of their pregnancy Emotional wellbeing support for an issue: As the pregnancy teams (i.e. sharing a room with other mothers
directly with their provider. Conversations about mental stress and do not feel supported by clinical
being disclosed to other. women who miscarriage in their progresses, women worry about and their babies after an stillbirth pregnancy)
Anecdotally, patients take time to health wellbeing can be sporadic, teams.
first trimester is limited. Currently their pregnancy remaining
develop trust and relationship with country-led education and support with women left feeling isolated Women who prefer an out-of-hospital birth (i.e. Women that give birth by C-section do not
confidential outside of trusted
their OB: this is due to appointments initiatives about miscarriage do not during their pregnancy. home birth) face significant challenges to opt for always feel sufficiently informed of the risks and
circles.
being perceived as too short or not exist. an ‘alternative birth experience’. postpartum considerations by their clinical team
empathetic.

Private Health Coverage

*All views captured in this document are those of the colleagues and patients interviewed
 Journey Map (Child Health) Touchpoint key
Patient personas Optional touchpoint Off-island touchpoint
An illustrative current-state experience of the end-to-end first 1,000 days pathway, from the perspective of the four personas to bring it to life*
PHASE
0-6 months 9 months 12 months 15 months 18 months 24 months

Angela 32-year-old first time mother who is Specialist care

Immunisation
Specialist care
Immunisation
Referrals Specialist care Immunisation & Screening
Specialist Immunisation Ref. Specialist Immunisation Ref. Specialist Immunisation &
Ref. Specialist
& Screening & Screening care & Screening care & Screening care Screening Immunisation & Screening
three months pregnant and works full- care
time as a legal secretary
Wants, needs, behaviours:
TOUCHPOINT 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 7.0 7.1 7.2 7.3 7.4 8.0 8.1 8.2 8.3 9.0 9.1 9.2 9.3 10.0 10.1 10.2 10.3 10.4 11.0 11.1 11.2 11.3 11.4

• Wants to be able to understand the My baby is seen My baby is My baby is My baby is My baby A health visitor My baby is My baby My baby is My baby My baby is My baby is My baby is A health My baby is My baby My baby is My baby is My baby A health My baby is My baby is My baby A health visitor My baby is My baby is My baby My baby A health My baby is My baby is My baby My baby My baby My baby attends
by a seen by a seen by a seen by a receives visits me and seen by a receives seen by a receives referred to referred to seen by a visitor visits referred to receives screened for seen by a receives visitor visits referred to seen by a receives visits me and referred to seen by a receives receives an visitor visits referred to seen by a receives receives an receives a CDP for a 2 year
care she and her baby will receive paediatrician/wel pediatrician/wel pediatrician/wel pediatrician/we immunisations my baby at pediatrician/ immunisations pediatrician/we immunisations early Happy pediatrician me and my early immunisations anaemia pediatrician/ immunisations me and my early pediatrician immunisations my baby at early pediatrician immunisations MCHAT me and my early pediatrician/ immunisations MCHAT referral for old assessment
l baby clinic at 1 l baby clinic at l baby clinic at ll baby clinic at home well baby ll baby clinic at intervention Valley Child /well baby baby at intervention well baby baby at intervention /well baby home intervention /well baby assessment baby at intervention well baby assessment CDP
• Empathetic and personalized week 2 weeks 4 weeks 2 months clinic at 4
months
6 months Care
Center
clinic at 9
months
home clinic at 12
months
home clinic at 15
months
clinic at
18months
home clinic at 24
months
communication showing that her
medical team truly cares
• Initially nervous about what to In person
expect from her pregnancy and
1.2 1.1 1.1 1.1 1.1 1.1 1.2 1.1

(setting)
birthing journey In person 1.2 1.2 1.1 1.2 1.1 1.1 1.1 1.1 1.2 1.1 1.2 1.1 1.2 1.1

(self)

CHANNELS
Private Basic Health Coverage In person 1.2 1.2 1.1 1.2

(home)

Phone 1.2 1.2 1.1 1.2 1.1 1.1 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.2 1.1

Vanessa 20-year-old first time mother who just

found out she is 4 months pregnant. She @ Email 1.2 1.2 1.1 1.1 1.1 1.1 1.1 1.2 1.1 1.1 1.2 1.1 1.2 1.1

is unemployed and wants to start college

next year
Wants, needs and behaviours:
• Lacks a social support network – she
lives with her parents who work full-
time
• Worried about not able to afford care
for herself and her baby
• Compassionate care and support to
address her other needs (i.e. financial)
• Rarely visits the doctor and her
medical records are limited.
GAIN POINTS
The positive experiences
which enhance the journey
and exceed patient and staff
expectations
Baby’s health is continuously Baby’s health is continuously
Paediatric visits follow the Bright The Child Health clinics provides pediatric
monitored through pediatric visits, monitored through pediatric visits,
Futures/American Academy of Pediatrics of services, and immunizations at no cost to
screening and immunisations. screening and immunizations.
well child care visits and follow the families (specially the uninsured)
periodicity schedule guidelines and best Referrals to early intervention All children attend a CPD
practice Health Visitors provide support and
advice to families, specially round services continue to take place where assessment at 2 years old.
Immunizations schedules for children breastfeeding and postpartum care during necessary.
are well promoted, accessible and the first 6 months Health visitors continue to support
Health visitors continue to support
education around immunizations is mothers with at-home visits where
mothers with at-home visits where
provided to families. Schedule follows needed.
needed.
WHO guidelines.

No insurance EMOTIONAL JOURNEY

An illustrative scale from -3 to
+3 to track the movements in
the citizens’ emotional journey
Laura 32-year-old reinsurance underwriter with
who recently relocated to Bermuda from
the USA
Wants, needs and behaviours:
• Has only experienced a midwife led
care pathway for her first pregnancy
• Prefers an out-of-hospital birth
• Trust in the team of doctors, nurses,
and staff that she is in the right care
and that her choices are respected
• Would like the support of a doula
Major Health Coverage
across the touchpoints
PAIN POINTS
The negative experiences
where the system is not
meeting expectations from
the perspective of both
citizens and staff
Information about developmental Families that access child health Access to autism assessments is
Women that have return to work after three months
milestones is provided to families in their services available through the public often delayed due to lack of
of maternity leave often struggle with breastfeeding
child health record book however, families clinics sometimes face issues with resources
and anxiety about bonding with their child.
find it difficult to understand or ‘translate’ long waiting lists and transportations.
Struggles with post-natal depression or mental
clinical guidelines
health challenges are not always timely picked up by
providers, leaving mothers feeling isolated. In Families facing access issues to
Families sometimes face long waiting
addition, access to mental health services outside the early intervention services (due to
lists to access essential services to meet
private setting are very limited long waiting lists) often feel
their child/children needs (i.e. early
unsupported with concerns about their
intervention) .
Whilst referrals to Happy Valley take place there is child/children development
a limited number of intake placements per year.

James is 34 and Natasha is 29 years

James & old. Natasha just gave birth to baby
Natasha Lucas, who was born premature at 30
weeks and flown overseas for his care
OPPORTUNITY AREAS
Wants, needs and behaviours: High-level identification of
the core opportunity areas
• Compassionate care as they that would have the greatest
impact on patient experience
struggle with knowing how to care
for their premmie baby
• Worried about services available on
island and long-waiting list to
access early intervention services
• They’d like to connect with other
families like them

Private Health Coverage

*All views captured in this document are those of the colleagues and patients interviewed