A service perspective on being born too soon

An estimated 15 million babies are born too soon every year. Preterm birth rates increase globally and affect rich countries as much as poor countries. USA, for example is one of the ten countries with the highest numbers of preterm births. The burden of preterm birth is substantial: According to a global rapport from the WHO, 1.1million babies die from preterm birth complications every year (Howson et al. 2012). However, the same WHO report suggests that over 75% of death of preterm birth can be prevented through feasible, cost-effective solutions including the Kangaroo Care method.

Applied Kangaroo Care, foto by Lærdal

The Kangaroo Care (KC) method is proven to have significant positive effects on both survival, growth, development and long term development of preterm infants in addition to parent-child-bonding and stress reduction (Conde-Agudelo and Belizán 2011). It is provided through parents (or substitutes) and with the support of health workers undertaken in neonatal intensive care units. Skin-to-skin contact in chest-to-chest position on the parents´s breast is providing the infant with the warmth that the little body cannot yet hold or produce itself. In addition, the infant is experiencing continuous stimulation through the parent´s own gentile body activity like the sound of the heartbeat, lung activity motion or voice.

The challenge

I felt this current topic was definitely worth spending my theses time and effort on. Even more, when I found out about the big gap between the high potential of the method and today’s actual implementation rate, as is shown in figure 2. What is the reason for bad acceptance and how can implementation be increased?

The KC implementation gap

Design / Methodology 

The main purpose of the thesis was to identify opportunities for scaling up Kangaroo Care (KC) method based on the five principles of service design defined by Stickdorn et al.(2010) I had chosen to apply design thinking methodology on 2 distinct settings, low resource settings and developed settings. The research question was explored through different workshops with experts and main user groups, covering various qualitative design tools as shown in the illustration of the design process in figure 3. The findings were analyzed on the background of the theoretical framework covering the research questions and the topic of value co-creation.

Design process theses


Five fields of opportunities for scaling up KC could be identified through the design process. In the theses, guidelines for each of these field were presented, and are summarized as follows:

KC is a complex service and needs to be tailored to the environment where it is implemented. At least one of the parents has to be taken out of their usual duties with all its consequences. The service has to focus on parent needs, taking their social and cultural situation fully into account. Enabling caregivers is therefor crucial for scaling up KC implementation.
The safety of the patient is key and is the ultimate goal in every step of the implementation. KC should not be conceived as a second best choice or alternative to safety. It is important to communicate that KC has to be offered together with all standard safety support that is available in the given setting and for the medical advantages that the treatment offers.

Health personnel has to be supportive to the concept which requires them to adapt working routines with focus on enabling parents through building competence.

Both groups need to build motivation by tangible made progress and provided feedback. Even under ideal conditions progress in development is slow and hardly visible for the involved. KC should therefor be supported by tools visualizing the progress. Whether supported by an app (as shown in figure 4), or by a simple paper chart, visualization builds competence and motivates.In low resource settings this support would also lead to increased patient safety.

KC support app blueprint

Proper implementation has the potential to save time and resources for health personnel by enabling parents to take a more active role in the care of their child. This may reduce time spent in the institution compared to incubator based neonatal care and consequently reduce costs for care payers.


KC implementations in various settings could potentially benefit from applying the guidelines formulated in this study. However, the guidelines should be validated by a broadening of the Evaluate phase with further independent experts. Including more users in the process is highly recommended. Concerning the suggested app, scenarios and prototyping would be the next step.

For the use in resource challenged settings, where lack of monitoring technology is a source for preventable death, one could envision a small portable device with a screen for interaction providing basic monitoring capabilities. In addition the same functions for visualization and education in adapted form should be offered. The conception of such a device would be a very exiting research project. Working on location would be suggested.


The course of this study program was both challenging and highly inspiring. The different backgrounds of the students – professionally and cultural – provided a unique energy in the classroom and I am thankful for having been a part of this. Personally caring teachers, lots of laughs in the classroom and some great lectures (unforgettable the connection between high speed sail boats and the world of elevators – I almost missed my plane!) made the long way worth while. As much as I am looking forward to be finished and to apply the learnings, I will miss this 🙂


Grönroos, Christian, and Johanna Gummerus. 2014. “The Service Revolution and Its Marketing Implications: Service Logic vs Service-Dominant Logic.” Managing Service Quality 24 (3). Emerald Group Publishing Limited: 206–29. doi:10.1108/MSQ-03-2014-0042.

March of Dimes, PMNCH, Save the Children, WHO. 2012. Born Too Soon: the Global Action Report on Preterm Birth.

Schneider, J, and M Stickdorn. 2010. This Is Service Design Thinking. Amsterdam: BIS Publishers.

Conde-Agudelo, A, and J M Belizán. 2011. “Kangaroo Mother Care to Reduce Morbidity and Mortality in Low Birthweight Infants.” Cochrane Database Syst.


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