CHILDREN'S AN EXPLORATION OF A HEALTH FAMILY-CENTERED SYSTEM OF TEXAS BUSINESS MODEL
children's
Ch ldren's Medical Center
CONTENTS 04
EXECUTIVE SUMMARY
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FOUNDATIONAL EXPLORATION
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MEDICAL HOME
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STAR KIDS
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SOUTH DALLAS CLINIC OFFERING
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FAMILY WELL-BEING BUSINESS MODEL
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CONTINUING TO SCALE
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CONCLUSION
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ACKNOWLEDGEMENTS & CREDITS
EXECUTIVE SUMMARY Introduction Children’s Health System of Texas (Children’s Health) serves the six counties that make up Northern Texas. It features a top-of-class pediatric emergency center, intensive care unit, community based ambulatory centers, and a wide range of services. In 2012, however, it recognized that a confluence of factors would eventually affect the sustainability of its business model. First, Children’s Health, like many hospital systems, was seeing a tremendous uptake in Emergency Department use for non-emergent situations (e.g., fevers, sore throats). A good number of these cases were either Medicaid or no-pay, affecting the economic performance of the model.
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PICTURE
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EXECUTIVE SUMMARY
Second, annual data pointed to the overall declining health of the population. Chronic conditions – like diabetes and asthma – were on the rise; generations of kids were no longer expected to live as long as their parents. Many of these problems are grounded in the social – or non-medical – determinants of health, such as poverty or housing. Third, health care was beginning to move from a fee-for-service model to a value-add service. In this new paradigm, health systems will be more lucrative if they are able to keep people healthy and out of care facilities. In this context, leadership at Children’s Health began to wonder:
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How might it move upstream and build a model that focuses on keeping people healthy? Children’s Health contracted the Business Innovation Factory (BIF) to help it understand how families in the Dallas–Fort Worth metroplex experience health, health care, and community life generally. This formed a foundational understanding of the job that families need done, which rested on three principles:
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Focus on the family rather than the individual
• •
Improve family well-being as a vehicle for improving health outcomes Marry efforts to address clinical care and the social determinants of health
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EXECUTIVE SUMMARY
In the years that followed this initial exploration, BIF applied this understanding to a variety of contexts, including: the existing medical home; a population of medically complex children and families; a new clinical care offering in South Dallas; and, ultimately to the design and testing of a wholly new business model.
Fall 2012
2013
Fall ‘12 - Spring ‘13 Foundational Research to Understand the Needs of Families
2014
Spring ‘13 - Summer ‘13
2015
Dec ‘14 - Summer ‘15
Applied Insights to the Medical Home
Explored Possibility of a Family Well-Being Model
2016
Fall ‘15 - Spring ‘16 Designed Clinical Care offering in South Dallas Dec. ‘15 - Feb. ‘16 Designed Value Added Services for Medically Complex Children Fall ‘15 - Dec. ‘16 Designed and Tested Family Well-Being Business Model
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Dec. 2016
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EXECUTIVE SUMMARY
APPROACH BIF’s approach is grounded in human-centered design—meaning it sought to learn from, and design for, the children and families in North Texas. Between 2012 and 2016, BIF applied a variety of tools to working with families: Ethnographic Interviews
Shadowing and Observation
BIF interviewed individuals, families, and system
By shadowing and observing individuals and families in
stakeholders (physicians, administrators, social
context (like the grocery store or the doctor’s office), BIF
service agencies) to understand their past and present
was able to get a fuller understanding of how people lived
experiences, probe for their mental models about health
their lives, the differences between what people said and
care, explore workarounds to the existing model, and
did, and the environmental factors that created barriers
uncover unmet needs.
to how they accessed the health care system.
Projection Activities
Participatory Design
Projection activities – like card sorting, journaling, or
Through participatory design, BIF moved beyond
collaging – allowed BIF to further probe into people’s
designing for a population to designing with a population.
mental models and ideal experiences to begin exploring
Participatory design brings together diverse users to
potential new paradigms for the health care experience.
co-create solutions. Participatory design often results in better fit solutions and models because they are designed by actual users.
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Critique
Prototyping
BIF used critique to generatively evaluate new solutions
Through prototyping, BIF created a tangible version of a
and models to ensure they reflect the integrity of
solution that others can experience. Prototypes can be
users’ early design principles and designs. In critique,
low-fidelity (e.g., a paper mock-up or storyboard) or
users evaluate concepts—reflecting what they like,
high-fidelity (e.g., role-playing an entire care experience).
what needs improvement, and what should be disregarded completely.
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EXECUTIVE SUMMARY
KEY FINDINGS From this work, BIF found that there are a number of disconnects between what families need and what the health care system is designed to do. • Health care is designed around the individual, but individuals operate in a family context. It is in the family that health care habits are learned, shared, and spread. The family context also creates a living environment that supports healthy or unhealthy decisions (e.g., as the types of snack foods that children have access to). To be effective, health care institutions need to consider how to serve the entire family. • Health is less tangible for individuals than other pressing priorities in their lives (e.g., earning a living or education). These factors are part of an indivual’s well-being. People are more interested in improving their well-being and that of their family. However, health care has only focused on improving individuals’ health outcomes. To effectively engage individuals, health care needs to focus on improving well-being as an avenue to improving health care outcomes.
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• Health care has excellent capabilities to treat people when they are sick. Capabilities to keep people well are treated as “extra,” making them less of a priority and less likely to be sustained. To be effective, health care institutions need to consider how to shift their center of gravity from sick care to well care. • Improving well-being is less about traditional wellness programs (e.g., weight management), and more about how to create the conditions to treat patients with empathy and dignity. The health care system was designed as an “expert” model (e.g., doctors are well-trained experts in diagnosing and treating illnesses). Often in this model, individuals’ own knowledge of their bodies and experiences is overlooked. Further, individuals’ own agency in their care is not leveraged as a critical component of care. To best engage individuals, health care institutions need to develop empathetic models of care, interact in ways that are non-hierarchical and trusting, and partner with individuals.
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EXECUTIVE SUMMARY
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CONCLUSION Through this body of work, BIF has demonstrated that there is a huge opportunity for Children’s Health to bridge the existing disconnects and not only effectively improve people’s well-being, but also better engage individuals in their health and health outcomes. This capability can be applied broadly—from a population of medically complex children to a clinical setting. It can also serve as an entirely new delivery system for the managed health organization. Further, this work has demonstrated that not only will this new experience change health outcomes, it will also differentiate Children’s Health in the market in a meaningful way for users.
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FOUNDATIONAL EXPLORATION The Five Elements of Well-Being From initial research on families in the Dallas area, the BIF team developed five insights about health and well-being. Each insight highlights a piece of the complex puzzle of human factors that make up the current health care experience, ranging from internal mindsets to external circumstances. Together, they describe the Elements of Well-Being. Families fall along a spectrum of well-being within each element. Some families struggle to meet the demands of their health and well-being needs. Others have positive health outlooks, understand the value of being healthy, and take action to better their health and well-being. It is within this range of behaviors that the BIF team saw possibilities for guiding families down the path towards well-being. 16
BALANCED OUTLOOK
SYSTEM OF SUPPORT
SENSE OF SELF ELEMENTS OF WELL-BEING
CONNECTED KNOWLEDGE
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PERSONAL POWER
FOUNDATIONAL EXPLORATION // ELEMENTS OF WELL-BEING
BALANCED OUTLOOK
FROM REACTIVE TO PROACTIVE For many families, life is a struggle to constantly optimize resources – time, energy, and money – and to mitigate crises. Other factors most often related to poverty, such as being a single parent, working multiple jobs, and living with chronic conditions, exacerbate this struggle. The BIF team found that families possess one of two outlooks that shape their decision-making and behaviors. Some families take on a reactive mindset—managing life from one activity to another, and one crisis to another, without the capability to reflect and plan. When it feels like life is one problem after another, it becomes hard for families to balance the demands of today with the needs of tomorrow. However, other families that live within the same conditions have a proactive mindset: they are able to focus on a longer-term horizon and understand the implications of short-term decisions. Trusted, reliable, and convenient sources of health information, as well as relevant and tangible returns on well care visits, can help move families from reactive mindsets to proactive ones.
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SENSE OF SELF
FROM UNSTABLE TO STABLE One’s sense of self provides a foundation for who they are, who they want to be, and their life priorities. This sense of self originates from experiences, and is reinforced both positively and negatively through intimate relationships with significant actors in their support network. Through these experiences, individuals begin to build values, priorities, and personal aspirations—all of which are ultimately internalized into their sense of self. People’s sense of self contributes to the importance that health has in their lives and their ability to maintain a healthy regimen. Those with an unstable sense of self haven’t yet internalized the values and benefits of making positive health decisions because healthy habits have not been consistently reinforced. On the other hand, those with a stable sense of self view health as an important part of who they are because it has been reinforced in their lives. As providers foster meaningful relationships with families that reinforce the values and benefits of making positive health decisions, families internalize these messages and more consistently engage in healthy behaviors.
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FOUNDATIONAL EXPLORATION // ELEMENTS OF WELL-BEING
PERSONAL POWER
FROM PROTECTIVE TO EXPLORATORY While families may have access to all the right tools and information, they do not feel confident to take matters into their own hands. Instead, they become dependent on those within the health care system, particularly the Emergency Department, to provide the care they need. This leads to an over-reliance on doctor’s visits as a source of reassurance. Some families have a protective mindset with respect to their health and well-being management. In this case, they attempt to limit exposure to stress and crises due to their lack of confidence in their abilities—thus, preventing the development of individual agency and self-management habits. Others may take on an exploratory mindset, where they feel confident in testing the boundaries of their abilities to care for themselves and their family. Health care experiences that allow for family input and use health care professionals to help guide behavior can give families the motivation to learn from their strengths and vulnerabilities—leading them to feel more engaged in their own health.
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CONNECTED KNOWLEDGE
FROM DISCONNECTED TO CONNECTED Knowledge is a critical piece of the care experience. By being able to access, interpret, and share information, families can make meaning out of the experiences that shape their health. With knowledge that is relevant and actionable, they can respond to life with more certainty and confidence. Much of the information given to families around their health is disconnected. It is often relayed in ways that do no have any relevance or meaning to the larger context of a family’s life. In addition, the knowledge is only given to those within the exam room, excluding the rest of the family’s support network. Conversely, connected knowledge is collaborative in nature, synthesized and actionable, and leaves families with a clear sense of how to address not only the direct factors, but also the social determinants of their health and well-being.
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FOUNDATIONAL EXPLORATION // ELEMENTS OF WELL-BEING
SYSTEM OF SUPPORT FROM LIMITED TO STRONG
Due to busy schedules and hectic lifestyles, many families depend on a number of trusted family members, friends, and other resources to help them with their care management. This system of support is deeper than a functional requirement; it provides families with a sense of stability and security. The current model of care doesn’t factor those key people into the primary care process. Instead, the system turns a family with a strong system of support – where multiple people play a role in caregiving – to one with a limited system of support—where the skills and knowledge that is learned about managing a child’s care are restricted to the people in the exam room. Inclusive health care experiences can help promote healthy behaviors across a family’s entire support network, leading to positive health outcomes.
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FOUNDATIONAL EXPLORATION // EMPATHETIC APPROACH TO CARE
AN EMPATHETIC APPROACH The Elements of Well-being and other insights from the foundational research led to numerous opportunities to rethink the current health care service and imagine a new approach. The main driver for this new health care paradigm was the importance placed on the interactions between the institution and the families being served. In order to reconfigure the system, BIF designed an empathetic approach that creates a respectful and convenient experience for families that deeply engages their health. Employing an empathetic approach can help health care providers see families as more than just patients, but also as people with hopes, concerns, and important lives outside of the exam room. By seeing families through this holistic lens, the health care system can better partner with them towards well-being along all five dimensions.
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WHAT MAKES FOR AN EMPATHETIC APPROACH? EMPATHETIC APPROACH
RESPECTFUL
CONVENIENT
• Create mutual partnerships through fair, flat, and transparent interactions
• Understand, respect, and accommodate families’ contextual circumstances
• Provide a safe space for open communication and vulnerability
• Communicate through multiple familiar channels
• Understand families' mindsets, motivations, goals, and challenges
• Help families navigate and comprehend health care information
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ENGAGING
• Engage all family members in experience • Provide value beyond health needs • Build families’ support network
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EMPATHETIC APPROACH TO CARE
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EMPATHETIC APPROACH
WELL-BEING OUTCOMES
TRUST BETWEEN FAMILIES AND HEALTH CARE PROVIDERS
creates a positive feedback loop
WELL-BEING OUTCOMES ALONG THREE SCALES INDIVIDUAL
• Tap into intrinsic motivation
• Encourage controlled experimentation
• Allow for self-reflection
• Individuals gain access to health care information
• Build well-being capacities COMMUNITY
• Connect families to one another
• Create connected flows of information
• Peer-to-peer support
• Build social capital
• Establish stability and security HEALTH CARE SYSTEM
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• Address needs of entire family
• Invest in families beyond health needs
• Deliver quality care
• Convenience for family
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SYSTEMIC IMPACT Engaging families in an empathetic way
INDIVIDUAL
creates well-being outcomes for the individual, the community, and the health care system. It establishes buy-in from families and helps to build trust between
Increased self-managed well-being
them and the health care institution. These empathic relationships – based on mutual respect for one another’s expertise,
COMMUNITY
knowledge, and experience – create a positive feedback loop, enabling more opportunities for sharing to occur, thus strengthening the bond betweenfamilies and
Ability to address social determinants of health
the health care system. Ultimately, the outcomes for the individual,
HEALTH CARE SYSTEM
the community, and the health care system can lead to lasting impact: Individuals are better equipped to self-manage their well-being, the community is better able to
Decreased burden on the system
address the social determinants of health, and the burden on the health care system decreases.
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FOUNDATIONAL EXPLORATION // DESIGN PRINCIPLES
DESIGN PRINCIPLES When designing any service or product, certain design principles, or guiding values, have to be followed to ensure that any solution is effective and desirable. BIF found that in order to create an empathetic family well-being experience, any solution must: • • • •
Honor families’ willingness to share and take what they say at face value Inform care through family expertise and narrative Provide avenues for social connection Develop families’ capacity and propensity to manage and make changes on the path to their own well-being
• •
Provide value to families, both as a unit and as individual family members Integrate resources to create a seamless experience tailored to families’ needs
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OPPORTUNITY SPACES In any design challenge there are multiple opportunity spaces— specific issues within the system that, when addressed in novel ways, have potential to create lasting impact. The BIF team identified the following opportunity spaces that can drive change within the health care system: • •
How might we build trusting relationships between families and the health care system? How might we promote an active role for families in their health and well-being management?
•
How might we create an experience that is convenient and flexible for the whole family?
• •
How might we establish safe spaces of support for families? How might we use an empathetic approach in caring for the whole family?
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APPLICATION:
CHILDREN’S HEALTH PEDIATRIC GROUP Improving the Medical Home: Empathetic Approach in a Clinical Setting Children’s Health established localized medical home facilities in communities to serve a pediatric population that had inadequate access to primary care. However, despite the presence of these facilities in underserved communities throughout the Dallas area, families continued to use the Emergency Department as a source of primary care. Children’s partnered with BIF to better understand individuals’ needs as it relates to their health and well-being in order to reduce the burden on the Emergency Department. 30
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MEDICAL HOME
DESIGN CHALLENGE The ultimate goal of these facilities was to reduce the inefficient use of the Children’s Health Emergency Department by managing children’s medical conditions through a localized medical home. However, despite the presence of CHPG in underserved communities throughout Dallas, families continued to use the Emergency Department as a source of primary care, while also experiencing poor health outcomes. CHPG was tasked with understanding individuals’ needs as it relates to their health and well-being in order to reduce the burden on the Emergency Department.
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APPROACH CHPG, Children’s Health, and the Business Innovation
individuals through their sick care and well care
Factory partnered to better comprehend the disconnect
appointments, and interviewing families before and after
between the individuals and the clinical offering. In order
their appointments.
to fully grasp the complexity of the landscape, BIF used strategic design and an empathetic approach with the
After the data collection phase, BIF analyzed and
families as well as the health care providers.
synthesized the data to uncover key trends. These patterns helped BIF generate ideas through landscape
To identify the capabilities already existent at CHPG, BIF
analysis and brainstorming sessions. Once these
invited key stakeholders to contribute to a CHPG and
methods for improvement were defined, the BIF team
Children’s Health capabilities map. This map, along with
established an experimentation strategy with CHPG by
contextual interviews with CHPG staff, helped the BIF
facilitating a synthesis workshop with CHPG leadership
team understand the landscape of people and resources
team and co-creating a solution road map.
available at CHPG. The other half of the puzzle for BIF was identifying the experience gaps for the families. To uncover these disconnects, the BIF team spent time observing the primary care process at CHPG, shadowing
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MEDICAL HOME
EXPERIENCE & GAPS From analyzing the observations and interviews, BIF recognized that the medical home model was designed for a set of behaviors and mindsets that its population rarely possessed. The following insights highlight the mismatch between the families’ needs and the clinical offering that often prevented families from managing their own wellness. These discrepancies also pointed to capabilities that CHPG needed to develop in order to bridge the various experience gaps.
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MEDICAL HOME // EXPERIENCE & GAPS
TO FAMILIES, ACCESS MEANS PROVIDING TOUCHPOINTS THAT MEET THEIR NEED FOR CONVENIENCE, REASSURANCE, AND TRUST. Most families served by CHPG understand the value of a sick visit. During a sick visit, parents expect, and often receive, a tangible outcome—a prescription, a shot, or a clear set of directions. This “return” provides a positive opportunity cost and justifies the visit. The value of well care appointments is often not apparent for families, especially if they must miss school or work, or spend a number of hours on public transportation in order to get to the appointment.
WELL CARE VISITS MUST PROVIDE A MEANINGFUL, RELEVANT, AND TANGIBLE RETURN TO FAMILIES IN ORDER TO MAKE THE BENEFITS OUTWEIGH THE COSTS. Within the current model, families are taught to manage their children’s care by equipping them with the proper medications, equipment, and information needed. But the model falls short in building families’ soft skills like confidence, agency, and independence. Families that aren’t engaged in their health don’t need more information. Instead, the motivational constraints that are limiting their engagement need to be assessed and addressed.
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ACCESS TO INFORMATION AND RESOURCES, IN CONJUNCTION WITH MOTIVATION, ALLOW FAMILIES TO BE INDEPENDENT AGENTS OF THEIR OWN HEALTH AND WELL-BEING. When care is physician-led, it takes the onus of understanding and making decisions about the trajectory of care away from the family. Parents and caregivers have an incredible depth of knowledge about their children, as do the children themselves. Yet many times, the expertise of the doctor trumps their intuitive judgments. Ultimately, families want to contribute their knowledge to the conversation while being given guidance and support from their doctor.
WELL-BEING SHOULD BE LED BY THE FAMILY, IN PARTNERSHIP WITH THE KNOWLEDGE AND RESOURCES OF THE PHYSICIAN. Many children, especially with asthma, tend to be kept away from health stressors and triggers. This mindset is encouraged by the health care system for the sake of avoiding liabilities. The message that many families receive is that the best way to manage their asthma is avoidance. This is not management; this is non-participation. In order to encourage an exploratory mindset, families need to be allowed to take risks and learn from their experiences, until they understand how to successfully manage their own health.
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MEDICAL HOME // EXPERIENCE & GAPS
PARENTS AND CHILDREN WILL LEARN FROM EXPERIENCES, INCLUDING MISTAKES AND FAILURES. The doctor-child relationship is framed by visits to the doctor’s office. Since the doctor usually sees children when they are sick, the relationship is seen through the narrow lens of this interaction. This not only perpetuates the development of the child’s identity as “sick”—especially for children with chronic conditions—but it also limits the doctor’s knowledge about the child and family to the topics discussed during the visit. Seeing parents and children as people with hopes and dreams, rather than only as patients, enables a new way to build rapport, trust, and engagement.
THE CHILD-DOCTOR RELATIONSHIP NEEDS TO EXIST OUTSIDE OF THE PARADIGM OF CARE. Currently, well care visits are framed in the scope of preventative care. During these visits, children’s general state of health is assessed, some brief recommendations or education is provided, and once they receive their scheduled immunizations, they are sent on their way. Yet these check-ups could be more meaningful to children and families if the discussion centered around both their physical and personal development. By linking physical development to personal ambitions, doctors could motivate children to make better short-term decisions and enable positive outcomes for their long-term health.
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WELL CARE VISITS NEED TO BRIDGE THE DEVELOPMENT OF CHILDREN’S PHYSICAL GROWTH AND PERSONAL GOALS. Many families rely on a number of people to provide care to their children. However, the current care delivery model constrains this support system by limiting the people who can attend appointments and how knowledge about the child is shared. By relying on one or two primary caregivers, the child’s support network is overlooked, information is heard second- or third-hand, and coordination of care falls to the primary caregiver even though they may not be well equipped to do the job.
PROPER CARE REQUIRES THE COORDINATION OF MULTIPLE PLAYERS IN A CHILD’S LIFE. Positive, healthy outcomes require healthy habits. Habits are learned, passed on, and even disrupted through one’s social network. By focusing solely on the child, CHPG is failing to tap into the power of habit. The support system that children rely on for care must become part of their behavior change process in order to help learn and reinforce healthy habits themselves.
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MEDICAL HOME // EXPERIENCE & GAPS
BEHAVIORAL CHANGE MUST BE LEARNED AND REINFORCED BY THE SUPPORT SYSTEM. In the current model of care, the health of a child is assessed through clinical measures and tests, as well as the discussions that transpire during visits. To obtain a fuller understanding of children in their environment, CHPG needs to move away from just relying on self-disclosure. For a more holistic picture on which to base goals, treatments and recommendations, doctors need a greater level of exploration and participation in children’s lives outside of the exam room.
HAVING A HOLISTIC PICTURE OF THE CHILD REQUIRES MORE THAN TALKING; IT REQUIRES ACTIVE PARTICIPATION WITHIN THE CHILD’S CONTEXT. During many primary care appointments, the exam becomes a forum to discuss the social factors that are currently affecting a child’s or family’s health, such as access to healthy food or housing issues. However, doctors are only able to do so much with their time, ability, and reimbursable activities. In order to guide families to more positive outcomes, CHPG needs to attend to the social determinants of health in addition to simply addressing their physical needs.
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FAMILIES NEED ACTIONABLE GOALS THAT ADDRESS THE ELEMENTS OF WELL-BEING AS WELL AS THE EXISTING CONDITIONS OF THEIR LIVES. A lack of common understanding between families and doctors can reduce family adherence to health plans. In order to facilitate this understanding, doctors need to explain concepts in a shared language—both linguistically and terminologically. In addition, doctors need to seek an understanding of the family’s attitudes, beliefs, and behaviors that may influence their ability to act on treatment plans and recommendations. With this common understanding, they can collaboratively set health goals and treatment plans that are consistent, communicated to a broad support network, and acted on collectively.
Collective action requires a common language, goals, and understanding.
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MEDICAL HOME
SOLUTION SETS
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MEDICAL HOME // SOLUTION SETS
01
Creating More Convenient Points of Access Families use the Emergency Department as a source for primary care because it is the easiest and most convenient source of care – with many decisions being made based on the optimization of time and effectiveness. Families want to make the best choice of care based on what they perceive to be the resource that will get them in and out with positive results. CHPG should give families the luxury of choosing more flexible options of care that fit into their lifestyle and needs. This means developing a co-created experience that understands what each family wants, expects, and needs to help bridge the disconnects in the medical home model.
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[Picture]
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MEDICAL HOME // SOLUTION SETS
ORIENTING FAMILIES TO THEIR HEALTH CARE RESOURCES
Why It’s Important
People, Process, and Technology
Many families who have had little engagement with health care outside of the Emergency Department
People: Orientation coordination; content
aren’t aware of the value that primary care brings
development and production; Updated
to their family. By providing new families with
offerings as they develop
an orientation to CHPG, the mission, value, and offerings of the medical home can be made relevant to their needs. During this orientation, well care and sick care visits are defined while
Process: Five minute sit-down orientation
supporting resources are introduced, such as the
with family before first appointment
nurse hotline and medicaid transportation. This orientation sets expectations with families about how CHPG and Children’s Health is structured and elucidates its offerings in comparison to the Emergency Department. It provides families with
Technology: Orientation deliverable (i.e.,
actionable knowledge about what to expect and
packet, interactive site); script for staff
establishes a friendly, welcoming introduction to CHPG.
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ESTABLISHING NORMS FOR THE DOCTOR VISIT
Why It’s Important
People, Process, and Technology
Families walk into CHPG with a spectrum of expectations and assumptions around what the doctor can and should provide. By setting
People: Buy-in from doctors
“norms,” or ground rules for the doctor’s visit, it sets up families to have accurate and feasible expectations, thus increasing customer satisfaction. it also provides a foundation for smooth collaboration between the doctor,
Process: Explanation during family
child, and family. These norms help set family
orientation; reminder during exam
expectations for collaboration with the doctor, establish boundaries of doctor-family abilities, and affirm collective responsibility and accountability for providing care.
Technology: Posters in the exam room
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MEDICAL HOME // SOLUTION SETS
PERSONALIZING FAMILIES’ CARE EXPERIENCE
Why It’s Important
People, Process, and Technology
Each family that walks through the doors of CHPG has a specific set of expectations, motivations, and needs that play a large role in how they engage in
People: Survey creation; doctor/
their care. To facilitate engagement, families can be
staff buy-in
taken through a series of questions and activities that uncover their personal preferences. This understanding will begin to build their personalized experience with CHPG and allow the doctor and staff
Process: Questionnaire that the family
to tailor their care and education around the family’s
completes before first appointment; review
expectations and needs. By personalizing the care
and discussion with doctor
experience, CHPG can establish a multi-directional relationship with families, helping to bring light to underlying expectations about the role they expect doctors to play in the management of their children’s Technology: Paper-based or digital survey
health. Ultimately, personalization can help doctors have a fuller, qualitative picture of the child.
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EXPANDING TOUCHPOINTS OF CARE
Why It’s Important
People, Process, and Technology
Health questions and issues arise for families in different circumstances throughout the day, but they are only able to access their personal doctor
People: Information systems support;
within an eight-hour window at the clinic. Tailoring
buy-in from doctor
both the method and moments of communication on the family’s terms increases the chance of
Process: Discussion with family during
getting in touch with their doctor, and allows the
orientation on the preferred method
doctor to follow up on their care without an office
and times of communication; follow up
visit. This ease of communication through multiple,
text/email/call after appointments; set
familiar channels keeps the care plan in the front
appointment reminders; discussion noted
of busy families’ minds. The expanded touchpoints
within computer system; reimbursement
also enables remote home monitoring and
for time spent
continuous education of chronic conditions.
Technology: New touchpoints of care; reimbursement model
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MEDICAL HOME // SOLUTION SETS
02
Establish a Sense of Control and Confidence in Individual Agency Many families struggle to manage their health and the health of their child, especially when they lack confidence in their own ability. By developing a sense of control and confidence in families, doctors can help them feel more in control through direct access to qualified, meaningful and actionable information that will help them triage for themselves. Families who have children with complex or chronic conditions usually take on the weight of symptom acknowledgement, triaging, and treatment on their own. Allowing the support system to access that knowledge can help to lift that burden off of one person’s shoulders – essentially decentralizing their care and treatment plan.
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[Picture]
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MEDICAL HOME // SOLUTION SETS
EXPANDING THE VISIBILITY AND VALUE OF CHPG
Why It’s Important
People, Process, and Technology
Currently, CHPG is constrained by limited touchpoints, generated by on-demand sick care visits
People: Coordination of outreach
and annual wellness visits. Marketing and outreach
opportunities; partnering with community
can help create more diversified opportunities to
organizations; liaison for the brand
reinforce CHPG as a trusted and relevant presence in the daily lives of children and families. That way, CHPG value extends beyond the concept of ‘Where I go when I’m sick’ to ‘Where they can impact my well-
Process: Identify, prioritize, and implement
being.’ The expanded visibility can reduce families’
outreach and/or marketing opportunities
sense of resource scarcity and reinforce CHPG as a reliable partner in life, not just during doctor’s appointments. The increased presence also opens opportunities to establish relationships with new families through outreach and marketing efforts.
Technology: Determined by identified opportunities
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EXPLORING POTENTIAL SCENARIOS WITHIN CHRONIC CARE MANAGEMENT
Why It’s Important
People, Process, and Technology
When a child is diagnosed with a chronic condition, the family has a long, difficult process of learning People: Scenario-building and production
to manage it. Children and their families are often unprepared to deal with these experiences. By staging real-life simulations, families gain the information, skills, and decision-making ability needed to properly care for and treat the condition. In addition, this process enables children and
Process: Doctor-child-family discussion of
families to learn in a safe place. This collaborative
condition; scenario walk-through
care management process between families and doctors allows families to understand reallife implications of the diagnosis and treatment and unearth gaps in knowledge, capabilities, or capacities in a safe environment.
Technology: Scenarios may be paperbased, digital, or interactive
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MEDICAL HOME // SOLUTION SETS
DEVELOPING PERSONALIZED CONTINGENCY PLANS
Why It’s Important
People, Process, and Technology
Many of the visits to the Emergency Department stem from families feeling unequipped to take People: Coordination of discussion
care of their child’s sudden illness. CHPG can help turn a reactive response into a proactive plan by creating personalized contingency plans that lay out clear directions for what to do in emergency
Process: Discussion, education, and
situations. This will proactively arm the family with
creation of plan around identifying
a shared plan while educating them about acute
symptoms, accurately triaging, and
and non-acute symptoms, as well as the appropriate
enabling access to care resources;
resources for triaging. Developing actionable
reviewing and adjusting plan after
contingency steps can help uncover constraints that
Emergency Department usage
hinder families’ use of appropriate care resources.
Technology: Contingency plan development guide; output of plan that is easily accessed and shared with others (through manual or digital technology)
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ESTABLISHING CARE CONTRACTS BETWEEN CARE PROVIDERS
Why It’s Important
People, Process, and Technology
Within the population, there is an increasing trend towards individuals having more than one chronic
People: Establishing legal clauses of
condition and/or having medically-complex cases.
care; buy-in from PCP, specialist(s), and
In response, the health care system gives them
family on contract
access to multiple specialists to help monitor and educate them. However, this simultaneously begins to blur the roles that the individual’s
Process: Establish a contract for care
primary care physician and specialists play in
that includes responsibility of advocating,
their care. By creating an agreed-upon protocol
education, and ongoing management of
or “contract of care” between the doctors and the
the treatment plan
family, each member understands their roles and responsibilities around care. This contract allows the family to know which provider is best equipped to take on certain responsibilities and increases
Technology: Care contract that is
the communication and collaboration across the
shareable across players on the care team
family’s entire care team.
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MEDICAL HOME // SOLUTION SETS
SHARING KNOWLEDGE WITH THE FAMILY’S PERSONAL ‘CARE COORDINATION TEAM’
Why It’s Important
People, Process, and Technology
Families rely on many people in their lives to help manage their children’s care. Usually, the
People: Coordination to ensure
coordination of this team of people rests on the
information is shared; authorization to
primary caregiver’s shoulders. Mapping this team
disclose health information; buy-in from
and helping to facilitate their coordination can lift
members of the family’s care team
part of this burden off one person and disseminate key information for more aligned care. Taking the responsibility of information-sharing off of the
Process: Personal care team mapping
caregiver ensures that others in the support system
exercise; determining best method of
have up-to-date knowledge and the ability to follow
sharing information with family’s care team
through with the care plan.
Technology: Mapping activities; shareable treatment plan; ability to distribute digitally or manually
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MEDICAL HOME // SOLUTION SETS
03
Making Health Tangible Health and well-being are difficult concepts for many people, especially children, to fully grasp. Not only do they have a limited understanding of how their actions today can affect their health later in their lives, but prescribed health goals don’t have much relevance to the things in their lives that are important to them. Making future outcomes more tangible and relevant to their lives, as well as providing action-oriented goals along the way, can help children become more accountable for their behaviors around their health.
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MEDICAL HOME // SOLUTION SETS
UNDERSTANDING CHILDREN FROM THEIR PERSPECTIVE
Why It’s Important
People, Process, and Technology
Children rarely play an active part in their own care. Seeing them as the experts of their own story can People: Survey administration
help them express their feelings about their health and well-being. Creating an activity that allows them to give different aspects of their health (including their physical, emotional, social, or cognitive health) a grade helps to ground the concept of health for
Process: Individuals take the survey
children, and encourage them to take an active role
before the appointment; doctor discusses
in their own care. By working to understand children
grades and provides necessary referrals,
from their perspective, CHPG will enable children
resources, or treatment plans
to have a voice in their health plan, and doctors will receive a more holistic view of the state of children’s well-being.
Technology: Grading survey tailored to the different developmental stages of the child and delivered in age-appropriate, engaging ways
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DEFINING AND ALIGNING INDIVIDUALS’ SHORTTERM GOALS AND LONG-TERM TRAJECTORY
Why It’s Important
People, Process, and Technology
All families are at different points along their path to well-being. Some require short-term solutions that help them manage their children’s chronic
People: Management of progress
conditions, such as keeping them out of the Emergency Department. Others are focused on a longer-term target to ensure their children are on the right path into adulthood. Defining short-term
Process: Collaborate with child and family
goals to create both small wins as well as a long-
on setting long-term personal health goal;
term trajectory can align families on the pathway
assign S.M.A.R.T. short-term goals; track
of care. In addition, clearly defined goals and
progress
trajectories keeps all care providers on the same page and creates milestones along the journey to well-being.
Technology: Shareable goal plan; digital or paper-based tool for tracking progress
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MEDICAL HOME // SOLUTION SETS
PARTNERING WITH EMERGING DIGITAL HEALTH OFFERINGS TO INCREASE ENGAGEMENT
Why It’s Important
People, Process, and Technology
There are an incredible number of resources geared towards children and health engagement that are
People: Partnership liaison; information
currently available. Tapping into these solutions
systems support; management of tools
broadens the doctor’s resource arsenal for educating,
and software; buy-in from doctor
providing real-time feedback, and tracking and monitoring behaviors. These solutions could become
Process: Establish health goals;
part of the child’s “prescription” or treatment plan,
“prescribe” digital health tool for further
such as digital health games (e.g., Monster Manor
education and/or goal tracking; set
or Re-Mission) as well as tracking technologies
weekly or monthly check-ins with doctor
(e.g., FitBit, Nike+, and JawBone). By tapping into
to track progress
children’s affinity for games, CHPG can increase children’s knowledge base and boost their feelings of self-efficacy.
Technology: Dependent on digital health tools implementation; modifications to the current AVS inputs and outputs
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CREATING A CLEAR, ACTIONABLE, AND SHAREABLE WELL-BEING SUMMARY
Why It’s Important
People, Process, and Technology
While families appreciate receiving an After Visit Summary (AVS) as a “receipt” from their
People: Doctor and front desk buy-in
doctor visit, the information could be more useful and actionable. Redesigning the AVS into a collaborative, goal-oriented document that can be
Process: Patient and caregiver input their
shared with other members of a child’s care team
expectations and questions for the exam;
and support system could help overcome current
doctor inputs information discussed
language barriers, more readily track progress,
during exam; information gets printed out
encourage adherence to a treatment plan, and
after exam and/or emailed to caregiver;
increase understanding of the child’s current health
caregiver and/or clinic shares summary
status. The new AVS would serve as a learning
with other authorized caregivers and
tool to help reinforce information that was given
doctors
verbally, focus on different aspects of health, make information simple and easy to understand, and provide a qualitative patient snapshot for the non-
Technology: Modifications to the current
primary care doctors.
AVS inputs and layout; data visualization capabilities
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MEDICAL HOME // SOLUTION SETS
CREATING A SAFE SPACE FOR INDIVIDUALS TO SHARE
Why It’s Important
People, Process, and Technology
Children aren’t always willing to share personal experiences while a caregiver is present. Doctors
People: Buy-in from caregiver(s), child,
can build a relationship with the child by being a
and doctor
trusted listener during sensitive topics, and providing guidance. Taking five minutes at the end of the well care visit for a “doctor/child confessional” allows the child and doctor to talk about a topic of their
Process: Ask the caregiver to leave at
choosing in a private environment where it is safe for
the end of the exam; engage child in a
them to share. Providing this safe, non-judgemental
discussion about a topic of their choosing;
space builds a deeper rapport between the child and
provide support and guidance
doctor, and allows doctors to address unhealthy or unsafe behaviors. Technology: None
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UNCOVERING MOTIVATIONS THAT DRIVE ENGAGEMENT
Why It’s Important
People, Process, and Technology
There are many motivational barriers that affect whether people will adopt or change behaviors. By assessing and addressing families’ level of
People: Targeted coaching;
understanding and knowledge, their readiness
tracking progress
and ability to engage, and their confidence around self-management, doctors can focus on improving key problem areas, helping families along the path
Process: Assessment of activation during
to engaging with their well-being. Recognizing that
each well care visit; personalized goal-
engagement is a developmental journey, doctors
setting to increase activation
can gain insight as to where to direct support, ultimately making more efficient use of resources to meet families’ needs.
Technology: Surveying tool
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MEDICAL HOME // SOLUTION SETS
04
Support, Inspire, and Guide First Generation Changemakers There is a small yet powerful trend of children breaking away from their family’s unhealthy outlook to develop healthy habits on their own. However, many of these first generation changemakers feel alone and isolated in their quest for well-being. CHPG can encourage this self-sustaining movement by connecting them to other changemakers, celebrating their successes with them, and supporting their behavior change within their households and communities.
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MEDICAL HOME // SOLUTION SETS
INSTILLING PRIDE THROUGH STORIES OF ACHIEVEMENT
Why It’s Important
People, Process, and Technology
Pride is a universal motivator for both children and adults. Sharing success stories enable children and
People: Interviewing/content creation;
families to tap into personal pride while highlighting
storytelling capabilities; buy-in from family
stories of possibilities for those on their journey. This builds child engagement through recognition of their achievements and creates a community of positive
Process: Staff nominates children and
role models.
families for health achievement; child/ family is notified and consent is provided; stories are shared with the community via a story-sharing platform
Technology: sharing platform (e.g. webbased, school program, video)
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FACILITATING EXPERIENCE-SHARING WITH CHILDREN AND FAMILIES
Why It’s Important
People, Process, and Technology
Families with children who are diagnosed with chronic conditions need help navigating the financial, educational, physical, and emotional
People: Management of enrollment;
pitfalls. Access to others with similar experiences
group facilitation and coordination
often feels serendipitous. Community-based children and family support groups help address this so families can more easily navigate the
Process: Enroll patients and families in
system. By sharing stories, advice, and support,
appropriate group; track progress and level
families have a better chance of successfully
of engagement
navigating their chronic conditions. Experiencesharing can help build a strong system of support, facilitate localized learning, and address relevant, age-appropriate issues.
Technology: None
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MEDICAL HOME // SOLUTION SETS
05
Provide Care Beyond the Child Health care is currently provided through the lens of limited and episodic visits to the doctor. This separates children from the influences that play a major role in their health and well-being—including the beliefs, values, attitudes, and habits that exist in their households. Additionally, CHPG scope of care ends not only after they leave the facility, but also after they age out of pediatric medicine. Extending the current scope of primary care allows doctors to better connect the child as a patient, the child as part of a larger family, and the child as a foundation to adulthood. By providing care beyond the child, CHPG can help families develop lifelong practices of well-being.
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MEDICAL HOME // SOLUTION SETS
ESTABLISHING HEALTHY HABITS BEGINNING AT BIRTH
Why It’s Important
People, Process, and Technology
Establishing a relationship between CHPG and expectant mothers through a maternity care
People: Liaison with obstetrician and
package can help parents welcome their child with
maternity wards of hospitals; coordination
the essential resources and information needed
of care packages
for positive development, as well as a personal pediatrician. Not only will this method help establish
Process: Provide care packages to
keystone habits that are important to health early
obstetricians to give to expectant mothers;
in the child’s development, it will also allow us to
establish contact with mothers to
expand providers’ panels through proactive contact
schedule their child’s first exam
with new families.
Technology: Care package and contents
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CONNECTING FAMILIES TO THE RESOURCES THEY NEED
Why It’s Important
People, Process, and Technology
Many of families’ health problems stem from issues that are often outside the scope of clinical
People: Community resource
care. While doctors and staff try to connect
liaison; coordination of resource
families to other resources, the process tends to
recommendations
be fragmented and unsystematized in the clinical setting. Furthermore, the offerings often lack relevance or clear direction for families. Inspired
Process: Assess individual family needs;
by the Health Leads model, families can be given
provide “prescription” for resource needs;
a directed and specific “prescription” for non-
track status of referral
medical factors that allows a community resource “expert” to coordinate and connect them to the right resources. In this way, CHPG addresses health issues affected by non-medical social
Technology: Either analog or digital
determinants by enabling access to personalized,
database of resources that is easily
relevant, and quality recommendations.
shareable and updated
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MEDICAL HOME // SOLUTION SETS
EASING THE TRANSITION OUT OF CHPG AND INTO ADULTHOOD
Why It’s Important
People, Process, and Technology
Transitioning from a pediatrician to an adult primary care doctor can be stressful and fraught with gaps in
People: Transition planning; buy-in of
care–especially for children with chronic or complex
adult primary care doctor
conditions. Ensuring that individuals have fostered the necessary skills to advocate for themselves, and building a transition plan well in advance, can help ease anxieties about the continuation of quality care
Process: Slowly build agency of children
in the pediatrician’s absence. Additionally, building
starting in adolescence; discuss transition
close ties with a network of adult primary care
plan with family in advance; discuss
doctors may enable closer collaboration on a child’s
relevant care information with new doctor
care plan and history through the transition. Technology: Transition plan; child agency “checklist”; digital or manual transference of child’s files to new doctor
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APPLICATION:
STAR Kids Empathetic approach to designing wraparound services for a medically complex population Children’s Health was awarded a Medicaid contract for the STAR Kids Program, a health plan catered to a population of vulnerable families with a medically complex child. To address the unique needs of these families, they collaborated with BIF and used strategic design and the empathetic approach to care to better understand service gaps and experiences of similar families at Children’s Complex Care Clinic.
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STAR KIDS
DESIGN CHALLENGE Starting in 2016, STAR Kids was the first Medicaid managed care program specifically serving families with children using disability-related Medicaid. In this expansion of Medicaid managed care, Children’s was asked to address the customized needs of these families as they relate to coordination of care, health outcomes, access, cost, administrative complexity, preventable events, and long-term services.
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APPROACH To address the unique needs of these families, BIF applied design strategy and an empathetic approach to better understand service gaps and experiences of similar families at Children’s Complex Care Clinic. This clinic is dedicated to caring for families who have a child, primarily on Medicaid, with complex diagnoses such as chronic lung disease, rare genetic disorders, congenital heart disease, and behavioral or neurological disorders.
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STAR KIDS
The clinic recruited a representative 17 families — four of whom only spoke Spanish. ETHNIC BACKGROUNDS:
7 6 5 4 3 2 1
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WHITE
CAUCASIAN OR
PACIFIC ISLANDER
ASIAN OR
MULTIRACIAL
OR BLACK
AFRICAN AMERICAN
LATINO/A
HISPANIC OR
0
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$75,000
OVER
$74,999
$50,000-
$49,999
$25,000-
$24,999
$15,000-
$14,999
UNDER
INCOME LEVELS:
7
6
5
4
3
2
1
0
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In order to best understand the needs and experiences
Second, BIF asked the participants to use a Venn
of these families, BIF conducted one hour of contextual
diagram and series of stickers to diagram qualities of
and semi-structured interviews with each family in their
their ideal vision for themselves, their child, and their
homes. BIF inquired about the family dynamic, child’s
family. Once they finished placing the qualities of their
diagnosis, hospitalization, information access, and the
ideal vision, BIF probed on the ones they included and
makings of both good and bad days. For a subset of
the ones they did not.
families, BIF asked them to share artifacts—such as Third, the BIF team facilitated a card sorting exercise
albums and organizing tools.
to identify highest pain points and participant-centered After the interviews, BIF facilitated one hour of generative
solutions related to aspects of the caregiver journey
research to shift the participants’ mindsets from present
with medical complexity. BIF asked participants to sort
to future and surface participant-centered solutions.
through 22 cards and choose three that they would love
First, BIF asked participants to envision and write
to completely redesign. After they chose, BIF probed on
down their ideal future for themselves, their child, and
how and why they would change those specific aspects.
their family. Finally, BIF asked if they would be closer to achieving the unattained components of their ideal vision if the three chosen journey aspects were redesigned—the answers were unanimously, “yes”.
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STAR KIDS
EXPERIENCE & GAPS Following home interviews, BIF analyzed findings and developed a comprehensive collection of experiences, gaps, and actionable solution sets for Children’s Health to develop wraparound services for the STAR Kids Program.
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STAR KIDS // EXPERIENCE & GAPS
COMPLEX DIAGNOSES AND WEAK IMMUNE SYSTEMS MEAN THESE CHILDREN ARE ALWAYS AT RISK FOR HOSPITALIZATION. Children born prematurely often spend their first year of life in the NICU. Despite these families’ efforts to prevent hospitalization, medically complex children often spend multiple days, weeks, or months in the hospital. The transitions between home and hospital represent significant challenges for these families to maintain any sense of normalcy. The hospital is the second home and the home has hospital-grade amenities and procedures. BUT these families do not feel at home in the hospital, nor are they well prepared for the medical requirements at home.
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THERE IS HIGH TURNOVER AND INCONSISTENCY WITH HOME NURSES, CAUSING MOM TO TAKE ON THE ADDITIONAL ROLES OF TRAINING NURSES, COVERING SHIFTS, AND LEADING COMMUNICATION. This is due to mismatched personality fit, complexity of diagnoses, unpredictability in a child’s health status, and the unique challenges for nurses in a non-medical environment. With high demand for and low supply of home nurses, home nursing companies are not resourced to provide the infrastructure and support needed to meet the specialized needs of these families. These families have nurses in the home for up to 24 hours a day. BUT there is high turnover and unreliability of home nurses which creates additional responsibilities and stress for mom.
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STAR KIDS // EXPERIENCE & GAPS
IN ORDER TO MAINTAIN THE FRAGILE ECOSYSTEM OF HER CHILD’S WELL-BEING, MOM RUNS THE HOME AS A WORKPLACE WHERE SHE MANAGES HOME NURSES. Responsibilities include interviewing, hiring, onboarding, evaluating, staffing, and firing home nurses. Highly successful moms proactively engage in conflict resolution and accommodate the home environment for nurse and child needs. A consequence of this environment is the feeling of “living in a fishbowl” and families feel unable to be themselves at home. The home is a workplace where mom manages home nurses. BUT there is great variability in mom’s capability and preparedness for this managerial role.
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THE UNPREDICTABILITY AND NEEDS OF AN IMMUNOCOMPROMISED CHILD CAUSE SOCIAL ISOLATION AND ANXIETY FOR THE CHILD’S FAMILY. Families orient their lives around avoiding triggers that lead to the child’s hospitalization, which often keeps the family from both going out and inviting others into the home. Cumbersome equipment as well as a lack of places for the entire family to go add to the social isolation and disconnectedness these families experience. These families orient their lives around avoiding germs, allergens, and judgement. BUT these families experience social isolation, compromised social well-being, and complicated interactions with others.
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STAR KIDS // EXPERIENCE & GAPS
FROM DIAGNOSIS TO DAILY LIFE, MOMS OFTEN LEARN MORE FROM PERSONAL OR PEER EXPERIENCES RATHER THAN HOSPITAL-PROVIDED TRAINING OR INFORMATION. When children are first diagnosed, doctors may communicate worst case scenario predictions of their futures, leaving moms feeling discouraged rather than empowered. Moms value others who have experiential expertise, leading them to give and receive support in the safety of their own home and in their own time, through online support groups and texting with peers. Moms seek and benefit from the understanding and expertise of others with similar experiences. BUT mom’s ability to connect is limited, and this connection is not formalized, making it dependent on mom’s proactiveness or luck.
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AT THE END OF THE DAY, MOM IS RESPONSIBLE FOR THE CHILD’S SURVIVAL. Mom seeks caregiving support from home nurses, remote peers, and/or family. She creates and maintains these support networks. Single moms are often more financially vulnerable, yet may have secondary caregiving help from their sisters or mothers. Married or partnered moms may have more financial stability, yet their partners frequently work long hours and are not expected to participate in primary caregiving when home. Mom is the one constant in the child’s life. BUT mom can’t comfortably leave the hospital room or home, which means she also can’t have a personal or professional life.
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STAR KIDS // EXPERIENCE & GAPS
IN NAVIGATING ALREADY COMPLEX MEDICAL DIAGNOSES, LANGUAGE BARRIERS AND CULTURAL DIFFERENCES MAKE THIS JOURNEY ESPECIALLY DIFFICULT. Crucial components that require a high level of navigation for all families include communicating with health care professionals, finding/keeping/communicating with home nurses and therapists, doing paperwork, finding information, and receiving peerto-peer support. Moms who are non-native English speakers work extra hard to communicate and secure both information and support. BUT moms lack access to information in their language and seek bilingual or culturally adaptive home nurses, as well as a community of culturally matched peers.
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PICTURE
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STAR KIDS
SOLUTION SETS
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01. CONNECT
04. EQUIP
02. RELIEVE
05. PROVIDE
03. ADAPT
06. REDUCE
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STAR KIDS // SOLUTION SETS
01. CONNECT
Connect Similar Moms and Families
SUMMARY The STAR Kids Program needs to help move families from being misunderstood and uninformed to being accepted and empowered. There is an opportunity to formalize and proactively provide peer-to-peer support networks – both online and offline – in environments that protect the fragile ecosystems of these children and accommodates mom’s limited availability to engage functionally and emotionally. CHARACTERISTICS
• •
Supportive solutions that are convenient, flexible, safe, and experientially sound. Functional solutions that are customized, patient centered, and have a person-to-person component.
SOLUTIONS
• • • •
Hospitalized Family Network Moms’ Sharing Economy Complex Care Alumni Outreach Journey Support Team
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HOSPITALIZED FAMILY NETWORK Potential Partners / Precedents
Create a service that enables hospitalized families to connect with one another in real time. This could be a mobile application that families download and
NextDoor Virtual Health
opt into during their hospital stay. Alternatively, this could be a person-to-person hospital program.
MOMS’ SHARING ECONOMY Potential Partners / Precedents
Create a platform for moms to pass along and/or sell accessories, equipment, and unused supplies.
Neighborhood Center’s Art Barn The Clothing Exchange DFW Child Helparound App
Families and others can quickly and conveniently post items mom no longer needs and search for ones she does.
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STAR KIDS // SOLUTION SETS
COMPLEX CARE ALUMNI OUTREACH Reach out to families who have the lived experience
Potential Partners / Precedents
of caring for a child with medical complexity—or a previously medically complex child/adult. Assign mentors to call families in need of hope and
JDRF Family Outreach Program
understanding from someone who’s been there but is now beyond the day-to-day struggles .
JOURNEY SUPPORT TEAM Work with moms to understand the range of experiences they face in caring for medically complex children. Create a program to assess, support, and
Potential Partners / Precedents
purposefully pair moms at different points in their journey from novice to expert caregiver. Identify
Virtual Health Programs Promotoro Program
moms who would be willing to provide short-term, convenient, needs-based peer support in exchange for compensation. Example: Mom who recently established her home environment is available for a quick call with mom who is preparing to head home. 98
PICTURE
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STAR KIDS // SOLUTION SETS
02. RELIEVE
Relieve Moms of Unnecessary Burdens SUMMARY STAR Kids needs to move from a model that causes mom unrelenting stress and constant uncertainty to one that shares responsibilities and provides consistency. Evaluating and redistributing the excess responsibilities that currently fall on mom’s shoulders and put her health at risk can help strike the necessary balance of Mom-as-Person and Mom-as-Caregiver. CHARACTERISTICS
•
Assessment solutions for mom that are in person, individualized, and delivered over time.
•
Respite solutions that merit mom’s trust and accommodate the high unpredictability of child’s condition.
SOLUTIONS
• • • •
Mom’s Assistant Medically Complex Child Care Co-Caregiver Training or Staffing Preventative Care For Caregivers
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MOM’S ASSISTANT Potential Partners / Precedents
Assess tasks outside of caregiving and hire someone to take responsibility for instrumentals
GoogleNow Care Navigator Churches TaskRabbit
of daily living such as cleaning, grocery shopping, preparing food, organizing the home, and spending time with other children.
MEDICALLY COMPLEX CHILD CARE Potential Partners / Precedents
Offer home-based service that provides child care providers experienced with medically complex children. Match care provider with child’s specific
Medically Complex Foster Care ChildCareGroup Bryan’s House
needs (physical, mental, emotional). This could offer partial to full days of coverage to relieve mom.
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STAR KIDS // SOLUTION SETS
CO-CAREGIVER TRAINING OR STAFFING Provide home-based training for interested and
Potential Partners / Precedents
capable family members to confidently watch child alongside qualified nurse. This expansion of the
EMT Partnership Avance Social Impact Architects
primary caregiver in-room discharge protocol would happen as desired and after transition to the home.
PREVENTATIVE CARE FOR CAREGIVERS Work with experts to assess mom’s well-being,
Potential Partners / Precedents
occupational hazards, and physical burdens associated with caregiving for her medically complex
Motivational Interviewing Social Workers Care Navigators Family Well-Being Quotient EMT partnership
child. Provide preventative care plan and supply methods, tools, and accessories to ensure mom’s physical health.
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PICTURE
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STAR KIDS // SOLUTION SETS
03. ADAPT
Adapt Hospital to Home & Home to Hospital
SUMMARY Moving from defined to flexible boundaries can best support families in the types of environments that maintain both child and family well-being. Softening the hospital and formalizing the home can help these families and their care team strike the necessary balance of normalcy and safety. CHARACTERISTICS
•
Balance home environments with sterile, procedural, and safe solutions— yet ensure it still feels like home.
•
Balance hospital environments with comfortable, familiar, and social solutions.
SOLUTIONS
• •
Transitional Mentorship Home/Hospital Environment Interventions
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TRANSITIONAL MENTORSHIP Potential Partners / Precedents
Hospital: Hire someone (experienced mom or social worker) to help mom get organized and create
Google Now Health Care Personal Assistants Promotoro Program Care Navigator MEND
communication tools that enable her to advocate for child’s well-being while hospitalized. Home: Send nurse manager home with novice mom for two to four weeks to help her interview and onboard new home nurses, and set up the home with medical equipment, supplies, and procedures.
HOME / HOSPITAL ENVIRONMENT INTERVENTIONS Potential Partners / Precedents
Tweak: Work with interior design specialists who understand both healthcare and live/work environments to assess and adapt the home and
bcWorkshop HKS Architects Doug Dietz, Kid-Friendly MRI
hospital for these families. Transformation: Create a new establishment that is a hospital, home, and work/social environment for these families. Think business incubator meets artist loft meets hospice center.
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STAR KIDS // SOLUTION SETS
04. EQUIP
Equip Moms & Nurses in New & Evolving Roles
SUMMARY STAR Kids needs to move from a model in which child well-being is dependent on the ability of moms to self-educate and self-manage to one that informs, equips, and supports them as they navigate their new and evolving roles. Providing moms with the necessary functional communication and interpersonal skills, resources, tools, and support can help ease the transition to, and maintenance of, care in the home. CHARACTERISTICS
•
Training solutions that are informed by experiential expertise, customized, and adapted over time.
•
Support solutions that are proactive, delivered person-to-person, and adapted over time.
SOLUTIONS
• • • • •
Crowdsourced Reviews Of Home Nurses Co-Manager Training or Staffing Mom As Manager Training Home Nurse Manager Staffing STAR Moms Consultancy
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CROWDSOURCED REVIEWS OF HOME NURSES Potential Partners / Precedents
Create a membership platform for moms to review and source quality home nurses and
Care.com Yelp CHST Interoperability Layer Member Web Portal
nurse companies. Users should be able to access information about quality, responsiveness, punctuality, and previous medical experience. Similar to Angie’s List, this platform needs to support real user reviews and ensure privacy.
CO-MANAGER TRAINING OR STAFFING Potential Partners / Precedents
Create home-based service to supply and/or train co-managers to help mom manage the home as workplace. This could be a compensated family
EMT Partnership Avance Social Impact Architects
member or qualified person supplied by a third party.
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STAR KIDS // SOLUTION SETS
HOME NURSE MANAGER STAFFING Potential Partners / Precedents
Employ a nurse manager to manage home nurses and nursing companies. The nurse manager would be
Patient Navigator Promotoro Program Patient Physician Network Holding Co., LLC Big Thought
home-based as needed and frequently check in with mom and nurses. Nurse managers would also serve as backup when scheduled nurses miss shifts.
MOM AS MANAGER TRAINING Develop a specialized program to turn moms into
Potential Partners / Precedents
masterful managers of home nurses. After the transition to the home, assess moms’ capabilities
The 60 Second Start Up Birthing Classes Go Noodle Virtual Health The Coopers Institute
in people management, conflict resolution, and establishing a positive working environment. Connect mom with appropriate resources to improve skills. Assessment and connection should happen in the home and throughout mom’s journey.
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STAR MOMS CONSULTANCY Create a consultancy that equips novice moms with
Potential Partners / Precedents
the tools and expertise needed for success, and Star Moms with opportunities to professionalize inherent and
Avance The Coopers Institute Promotoro Program
acquired capabilities. Novice Moms: Assess needs and customize team to best foster success. For example, Novice Mom is great at organizing but needs help with people management. Star Moms: Assess and professionalize each Star Moms’ particular strengths and determine her potential role(s) in the consultancy. For example, Star Mom excels in resolving conflicts among nurses.
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STAR KIDS // SOLUTION SETS
05. PROVIDE
Provide Opportunities for Moms to Personally Develop SUMMARY The STAR Kids Program needs to move moms from unpaid and overworked to paid and balanced caregivers for their child. Providing moms with sustainable, actionable, and individualized support can help them become more financially stable and personally fulfilled. CHARACTERISTICS
• •
Career and education solutions that are flexible in terms of time and place. Personal development solutions that are customized, actionable, and delivered over time.
SOLUTIONS
• • •
Coached Online Classes and Work Caregivers With Careers Mom Life Services
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COACHED ONLINE CLASSES AND WORK Potential Partners / Precedents
Provide in-person evaluations of mom’s unique capabilities and career/educational goals. Advise
Khan Academy College for America Care Navigator Avance
mom of flexible options related to her potential, such as online prerequisite classes and freelance job opportunities. Collaborate to create an actionable plan and establish frequent check-ins.
CAREGIVERS WITH CAREERS Potential Partners / Precedents
Hospital: Work with moms to identify desired classes related to interests, self-care, and career paths. Bring experts in to develop programs and facilitate
YMCA Churches UT Southwestern Housing Authorities EMT
sessions. Based on interest, provide accredited courses and pathways to degrees in hospital. Home: Work with a college or university to create a flexible degree-granting program. Assess each mom’s inherent and acquired skills, and plan a degree path.
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STAR KIDS // SOLUTION SETS
MOM LIFE SERVICES Create a program of experts to support moms
Potential Partners / Precedents
in pursuit of their personal paths. Hire someone to evaluate mom’s needs and connect her to
Avance Your Best You Curriculum Children At-Risk Motivational Interviewing
appropriate support (e.g., Academic Advisor, Career Counselor, Psychologist).
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PICTURE
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STAR KIDS // SOLUTION SETS
06. REDUCE
Reduce Barriers to Social Life SUMMARY The STAR KIDS Program needs to move families from isolated to inclusive experiences with the outside world by providing them with tools, environments, and guidance that enable social wellness for the child and family as a whole. CHARACTERISTICS
•
Social solutions for whole family that are safe: non-judgmental, germ and allergen-free, and equipment-friendly.
SOLUTIONS
• • •
Networked Social Play Social Accessories Controlled and Inclusive Spaces
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NETWORKED SOCIAL PLAY Potential Partners / Precedents
Collaborate with robotics/game company or academic institution to source and/or create networked toys,
Virtual Health vGO Communications (already in 8 schools in Texas) Aldebaran Robotics Personal Robots Group at MIT Media Lab
child-friendly telepresent robots, or socially interactive experiences for medically complex children. Implement solutions for immunocompromised children to enable social play and education in the safe environment of the home or hospital.
SOCIAL ACCESSORIES Potential Partners / Precedents
Online Resource: Create a resource for moms to learn about and acquire accessories that facilitate social normalcy (e.g., Upsee).
Dallas Design District Social Impact Architects Care Coordination
Design Studio: Collaborate with a local university to create a hospital-sponsored product design studio. Through home visits with mom, design problems would surface and solutions would be fabricated. moms and students could receive profits if the innovation is scalable.
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STAR KIDS // SOLUTION SETS
CONTROLLED AND INCLUSIVE SPACES Create events and spaces that are appropriate
Potential Partners / Precedents
and inclusive for these families (e.g., social events at hospital). Implement preventative procedures
Children’s Family Health Clinics Asthma Camp The Arc of Dallas YMCA Churches
to reduce exposure to potential allergens and germs. Ensure accessibility of equipment and enable familiar social networks where children are understood and medically safe.
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PICTURE
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APPLICATION:
SOUTH DALLAS CLINIC OFFERING Empathetic Approach to Designing a Family Clinic While assessing the business opportunity to create a family-health clinic, Children’s Health sought to co-create the consumer experience with families. To this end, Children’s Health worked with BIF to develop Citizens Design for Health, an exploration to identify how to translate the elements of well-being to a family health offering.
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SOUTH DALLAS CLINIC OFFERING
OVERVIEW In 2015, Children’s Health explored an opportunity to purchase a property in South Dallas, and to repurpose it as a family-health clinic. While assessing the business opportunity, Children’s Health also sought to explore the consumer experience. What did consumers want and need in a family health offering? Citizens Design for Health (CD4H) was an exploration to identify how to translate the elements of wellness to a family health offering, and to work closely with families in the Oak Cliff and Redbird communities to co-create health care offerings crafted to meet their needs and desires. Working with families, it became clear that they desire a physical, trusted location in the community to care for their families’ holistic needs, medical, and beyond. Six elements comprised the ideal experience: accessible frontline of clinic, family centered service and amenities, convenient learning opportunities, participatory care experiences, flexible financial platform, and engaging clinic culture.
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DESIGN CHALLENGE How might we design a family health offering around the elements of wellness? What are the key elements that families want and need in a clinical offering? What are the central elements of the experience?
APPROACH The project consisted of three segments: family interviews, a participatory design program, and offering development. In the participatory design program, participants were trained in the design process and used it to design their ideal family health experience. The elements that they designed were then translated into a strategic roadmap and implementation guide.
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SOUTH DALLAS CLINIC OFFERING
PARTICIPANTS CAME FROM THE REDBIRD AND OAK CLIFF COMMUNITIES IN SOUTH DALLAS. THE FOLLOWING DATA REFLECTS THE POPULATION STATISTICS FROM 2014. HOUSEHOLD COMPOSITION of the South Dallas families were single parents with children
• •
Single females primarily lead African-American families Hispanic households are overwhelmingly married, two-parent households
of the population lived in poverty
• •
Poverty impacts both African-American and Hispanic families Families must prioritize bills and healthcare visits due to tight financial conditions
of the community had not attained a high school diploma
•
Both African-American and Hispanic parents prioritize enrolling their children in the best area schools, valuing education for social mobility Parents also seek out affordable learning opportunities in the community for their families
POVERTY LEVEL
EDUCATION LEVEL
•
All data is from 2014, and was provided by Easy Analytic Software, Inc. (EASI) - Enhanced Master Database, including Census Daya, ACS Survey, and EASI proprietary model
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PROJECT COMMUNITY REPRESENTATION: INTERVIEWS 7 AFRICAN-AMERICAN FAMILIES
20 HISPANIC FAMILIES
3 single mothers
3 single mothers
2 extended family as caregiver
2 extended family as caregiver
2 married or cohabitating partner
2 married or cohabitating partner
CITIZEN DESIGN FOR HEALTH PROGRAM 8 AFRICAN-AMERICAN FAMILIES
12 HISPANIC FAMILIES
6 single mothers
1 single mothers
1 extended family as caregiver
11 married or cohabitating partner
1 married or cohabitating partner
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SOUTH DALLAS CLINIC OFFERING
EXPERIENCE GAPS From interviews and working with families, BIF identified seven experience gaps that informed the new offering.
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SOUTH DALLAS CLINIC OFFERING // EXPERIENCE & GAPS
INDIVIDUALS, FAMILIES, AND CLINIC STAFF REPRESENT MANY TYPES OF “DIFFERENT”—LANGUAGE, CULTURES, PERSPECTIVES, AND VALUES. Empathetic, mindful, and “flat” interactions create the foundation for trusted and respectful partnerships.
FAMILIES FEEL RESPONSIBLE FOR THE OUTCOMES OF THEIR HEALTHCARE EXPERIENCE—FROM MANAGING THEIR CARE TO PAYING FOR IT. They do not feel they have enough knowledge, control, or power to fulfill their obligations, and they are terrified of unknown consequences of bad decisions.
FAMILIES FEEL ACCOUNTABLE FOR THEIR HEALTH OUTCOMES AND EXPERIENCE. They expect to be invited into their care assessment and planning, with robust opportunities for input, feedback, and discussion.
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CONVENIENT AND ACCESSIBLE CARE OPTIMIZES FOR NEEDS ACROSS FAMILY, CONDITIONS, AND CONSTRAINTS. Services need to seamlessly coordinate appointments, information, care plans, and daily living needs – while reducing barriers to participation.
FOR FAMILIES, THE HEALTH CARE EXPERIENCE SHOULD BE AS MUCH ABOUT BUILDING HEALTH AND WELL-BEING AS IT IS ABOUT SICK AND PREVENTATIVE CARE. SYSTEMS OF SUPPORT AND COMMUNITY CONNECTIONS CONTRIBUTE TO FAMILIES’ SENSE OF WELL-BEING AND ENABLE GOOD INFORMATION FLOW. However, opportunities for connection and participation are few and far between.
FINANCIAL PLANNING IS A KEY COMPONENT OF ACCESSING HEALTHCARE. Families make calculated life decisions to optimize available resources and avoid repercussions from inability to pay.
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SOUTH DALLAS CLINIC OFFERING
SOLUTION SETS
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SOUTH DALLAS CLINIC OFFERING // SOLUTION SETS
RECOMMENDED OFFERINGS
Six offerings for the Family Health Clinic emerged as the most robust and highly-needed for the community:
Accessible Frontline of the Clinic
Participatory Care Experiences
Family-Centered Services & Amenities
Flexible Financial Platform
Convenient Learning Opporunities
Engaging Clinic Culture
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FAMILY WELL-BEING CLINIC — PEOPLE Representatives comprise
Providers are the quarterback
the frontline of clinic
of the healthcare team, working
communication and guide
with families, patients, and
families through clinic
clinic staff to deliver holistic
processes, answer questions,
medical care.
and coordinate services.
Nurses and medical aides set
Financial advisors address
the stage for the medical care
families’ financial concerns
experience by crafting norms
regarding care and help families
with families and gathering
develop personal budgets and
information for delivering
flexible payment plans for all
effective medical care.
clinic services.
Employees and volunteers of value-added centers and services are the intersection point between the clinic and the community. They are anyone hired or enlisted to serve families at the clinic.
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SOUTH DALLAS CLINIC OFFERING // SOLUTION SETS
ACCESSIBLE FRONTLINE OF THE CLINIC The frontline reduces barriers for family participation in the healthcare experience and help families gain knowledge and control to make informed healthcare decisions.
Core Functions Family-Staff Interactions
Written Information
•
•
•
Families have multiple channels to contact and meet with staff.
clinic processes and offered medical, financial
Staff engage families in an understandable
and value-added services
•
manner and in their preferred language.
•
Available on multiple channels and explain
Simple and family-facing, in families’ preferred
Families’ appointments and transportation are
languages, and use visual storytelling to convey
scheduled in a timely manner.
meaning.
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People, Process, and Technology People:
• • •
Representatives Nurses & Medical Aides Financial Advisors
Process:
•
Clinic representatives, nurses, and
•
Staff use written documents and
financial advisors are available
clarifying aids to engender family
to answer all questions and
understanding.
engage with families regarding
•
Representatives visit prominent
clinic services, medical care, and
locations within the community to
financial planning.
assist families in accessing clinic services.
Technology:
• •
•
Mailing system to send families
24-hour phone line for scheduling and
updates about care, opportunities at
answering families’ questions
the clinic, and bills
Online platform housing general
•
Clear, family-facing documents
information and personal financial and
including maps and signs, as well as
medical care information for patients
medical and financial information
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SOUTH DALLAS CLINIC OFFERING // SOLUTION SETS
FAMILY-CENTERED SERVICES & AMENITIES Clinic staff work to provide a holistic, valuable care experience for families and reducing barriers to family participation in the healthcare process by supporting the various roles and responsibilities of each family member.
Core Functions Value-Added Services
Family-Centered Amenities
Coordinating Family Care
•
•
•
•
Include entertainment, food
Designed for whole family
Medical appointments are
services, child care, counseling,
unit—opportunities to engage
available for multiple family
tutoring, community services,
children are present throughout
members simultaneously, either
and learning opportunities.
the clinic.
to be seen separately or together in a family appointment.
All value-added services are coordinated to engage all family members.
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People, Process, and Technology People:
• • •
Representatives Providers Employees & volunteers of value-added centers
Process:
•
•
Representatives and employees of individual
•
Providers see families together
centers at the Clinic meet regularly to
or as individuals, depending on
coordinate services and activities to help
the family’s preference, using
families meet their various needs.
age-specific tools and learning
Childcare staff members are available so
aids with each family member.
parents can focus on their own care or the care of a sick child. Technology:
•
Interaction areas: entertainment zone, technology area, cafeteria, privacy rooms, classrooms, counseling areas, learning lab
•
Family-sized and kid-friendly amenities and tools
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•
Infrastructure for clinic staff to coordinate services and activities
SOUTH DALLAS CLINIC OFFERING // SOLUTION SETS
CONVENIENT LEARNING OPPORTUNITIES Providing accessible learning opportunities help families grow personally and as family units in ways that can aid their well-being and help them meet their basic needs.
Core Functions Opportunities for the Community
Opportunities for Patients and Families
•
•
Enrollment in affordable classes or sign up for memberships to clinic services
•
Free, age-specific workshops provided for patients and their families
Volunteer opportunities for community to teach classes in exchange for clinic services at a reduced cost
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People, Process, and Technology People:
• • •
Representatives Nurses & Medical Aides Employees & volunteers of value-added centers
Process:
•
•
Representatives meet with community
•
Clinic staff develop a coordinated
partners to recruit teachers for workshops
schedule with offerings for both adults
and classes.
and children.
Medical staff and community members
•
Representatives and teachers
teach workshops for waiting patients and
document family involvement in classes
classes for community members.
and workshops to inform providers’ medical care recommendations.
Technology:
•
Family-facing, visual class schedules and lists
• •
Classroom space and computers Platform for course offerings and enrollment database
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SOUTH DALLAS CLINIC OFFERING // SOLUTION SETS
PARTICIPATORY CARE EXPERIENCE Clinic staff create a flat care environment for patients and their families, engendering a trusting and respectful relationship and helping families gain knowledge and control to confidently fulfill their responsibilities surrounding care.
Core Functions Establishing Rules and Expectations
Family-Facing Information
•
•
Families co-create the meaning of fair treatment and expectations for care with
information is easy to understand, shared in the
medical staff.
family’s preferred language, and rely on visuals to convey meaning.
Feedback and Involvement
• •
All orientational, procedural, and medical
Providers and staff use patient narrative to involve
Empathetic and Mindful Interactions
families in the medical process.
•
Staff and providers connect with families in
Staff listen to and answer all questions from
a respectful and engaging way, fostering a
families and seek out their feedback for continual
relationship with families that extends beyond the
improvement.
exam room.
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People, Process, and Technology People:
• • •
Representatives Nurses & Medical Aides Providers
Process:
•
•
Representatives, nurses and medical aides
•
Immediately after the visit, providers
orient families and work with families to
give families the opportunity to provide
establish norms around care.
feedback.
As families receive care, nurses, medical aides
•
A few days after the visit, clinic
and providers use narrative, listening, learning
representatives follow up with families via
aids, and co-creation activities to establish a
their preferred communication channel.
transparent, understandable, connected, and engaging clinical care experience. Technology:
•
Platform for communication between clinic
•
staff and providers
•
infrastructure
Interpersonal communication tools to engage patients in the healthcare process
•
Robust family and community feedback
Tools to capture patient narrative and engage family members and children in the process of care
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•
Clear after-visit information including summary of care and treatment plans
SOUTH DALLAS CLINIC OFFERING // SOLUTION SETS
FLEXIBLE FINANCIAL PLATFORM The financial platform expands the community’s access to quality medical care and provides families with knowledge and control to fulfill their financial responsibilities. These outcomes create the foundation for a trusted and respectful partnership between the community and the clinic.
Core Functions Flexible Payment Structure
Financial Advising
•
•
Accepts patients with any health insurance coverage status and type of coverage
•
navigate the financing and insurance processes.
•
Includes a robust, flexible payment infrastructure to assist those with financial need
Advisors estimate care costs, customize payment plans and create budgets with families.
Transparent Financial Information
• •
Financial Advisors explain and help families
Family-facing written information Prices and payment options for all services are posted in the clinic and on multiple communication channels.
140
People, Process, and Technology People:
• • •
Financial Advisors Representatives Providers
Process:
•
•
Representatives post family-facing financial
•
Providers have access to families’
information on all communication channels
financial plans, using the information to
and throughout the clinic.
discuss care options with them.
Financial advisors meet with families before
•
Financial advisors give families a
and after care visits to set up personal
comprehensive agreement and send
payment plans and budgets.
reminders before billing payments.
Technology:
• •
Family-facing financial documents, web
A platform that allows for
pages, and posters
communication among clinic staff
A flexible financing infrastructure that
regarding families’ financial plans
accepts all types of insurance and
•
•
•
A family-facing platform for families to
customizes payment options for families
access personal and procedural financial
A financial aid and grant system to support
information
families with payments
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SOUTH DALLAS CLINIC OFFERING // SOLUTION SETS
ENGAGING CLINIC CULTURE Establishing a familiar, culturally-reflective environment fulfills families’ desires to be respected and understood by clinic staff and facilitates a trusted connection between the Clinic and the community.
Core Functions Engaging Families in a
Soliciting Family and Community Feedback
Culturally-Competent Manner
•
• • •
Staff interact with families in a culturally
environment and context of their entire care
sensitive and respectful way.
experience.
•
The clinic hires multilingual staff and providers.
Clinic representatives develop strong
The clinic provides culturally-relevant, highly
community partnerships and meet with families
visual signs in multiple languages.
in the community.
•
Reflecting the Culture of the Community
• •
Families are invited to co-create the
The clinic is located in a central and familiar location. All staff reflect the diverse community.
142
Clinic staff use family feedback to develop services desired by the community.
People, Process, and Technology People:
• • • • •
Representatives Nurses and medical aides Providers Financial Advisors Employees and volunteers
Process:
•
with clinic staff and families in the community
•
core values, beliefs and behaviors.
that they are highly visual and universally
The clinic hires multilingual staff – particularly
understood by the community.
•
Representatives meet with community
to engage families.
leaders and organizations to establish
The clinic develops its culture through staff
partnerships in the community.
Technology: In-house translation and interpretation services Robust family and community input and feedback infrastructure
•
Clinic staff translate all documents and signs in multiple languages, taking care
professional development, family-staff
• •
•
to define the clinic’s culture, identifying desired
those who speak fluent English and Spanish –
•
meetings, and community partnerships.
The clinic holds workshops and discussions
Community-facing interaction areas
143
APPLICATION:
FAMILY WELL-BEING BUSINESS MODEL AN EMPATHY-BASED BUSINESS MODEL Children’s Health sought to move beyond their current model because despite delivering excellent care, inappropriate and costly utilization of emergency care continued. They realized the problem was significantly larger than the existing business model could address. To this end, Children’s partnered with BIF to design and test a patient-centered model that would support families efforts to improve their well-being, by integrating an empathic approach and addressing the social determinants of health.
144
145
FAMILY WELL-BEING BUSINESS MODEL
Efforts to bring empathy to health care, create a patient-centered delivery model, merge the social determinants of health, or address wellness and well-being are not new to health care. The challenge has always been that these efforts are treated as “bolt-ons” to the core business model—established as separate programs, initiatives, or efforts. As such, organizations fail to make these efforts sustainable or priorities, and often don’t build the necessary capabilities to deliver these programs well. Children’s Health sought to move beyond this paradigm. While they applied the learnings to the existing business model, the problem was significantly larger than what this model could address. Despite excellent care, the health of the population continued to decline. Simultaneously, increasing costs and a shift to value-based care made the existing fee-for-service model unsustainable. The call became to not just improve the existing business model by integrating empathy, the social determinants of health, and family wellbeing. The imperative became to design and prototype a new business model that would focus on family well-being.
146
DESIGN CHALLENGE A series of interlocking questions drove the design of the new business model: How might we move upstream to design a business model that focuses on keeping people healthy? How might a focus on the family enable Children’s Health to address the system in which children grow up? How might we enable first generation changemakers to make changes at the individual and family levels? If we improve well-being, can we improve health outcomes?
APPROACH Exploring a new business model was comprised of
Business model experimentation requires designing
two steps; business model design and business model
the minimum viable business model – a high fidelity
experimentation.
prototype comprised of the core capabilities – that real users can experience. It also requires an
Business model design requires crafting a story about
experimentation strategy that defines where to
how the organization will create value or solve a problem
experiment and with whom. The approach should be
for the end-user, how the organization will deliver value
comprehensive to test all elements of the model, and
or organize capabilities, and how the organization will
it should be within a small enough environment and
capture value. This is a process that builds from the
sample such that it can be adapted in real time.
foundational work, insights, and the elements of wellbeing, but also includes significant co-creation with and critique by families.
147
FAMILY WELL-BEING BUSINESS MODEL
NEW MODEL DESIGN: VALUE PROPOSITION The value proposition defines the promise to the end-user, articulating the problem they are trying to solve and how Children’s Health intends to address this challenge.
148
Children’s Health Value Proposition You want to improve the well-being of your family. We want to help. Together, we will: • Surface and address the issues that are helping or hurting your family’s journey to physical, social, spiritual, emotional, and mental wellness • Tap into your individual and shared goals to support positive lifestyle changes so they are developed and sustained as a family • Organize resources, including information and services, so they are meaningful and relevant to you • Define the right care at the right time in the right place for the right need • Integrate all of these offerings in the places that you live, work, and play so they are easily accessible when and where you need them
149
FAMILY WELL-BEING BUSINESS MODEL
NEW MODEL DESIGN: DELIVERY MODEL The delivery model defines the core capabilities required to deliver on the value proposition and illustrates how they will connect together. The new model puts the family at the center of the business model, integrating medical care and community support services (to address the social determinants of health) through financial vehicles that can use portions of the insurance premium dollar to pay for the medical and nonmedical determinants of health.
150
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FAMILY WELL-BEING BUSINESS MODEL
EXPERIMENTATION STRATEGY To test the model, BIF designed a prototype that would support families’ efforts to improve their well-being, integrating medical and clinical care. The experimentation was designed for a small population of 15 -25 families with a mix of private and public health insurance. Each family would include no more than five family members. Other than that, BIF put no specifications on how to define “family”—meaning it could include a nuclear family, married or non-married couples, single parents, grandparents, etc. Because the business model is population-based, BIF sought a place-based approach to experimentation. BIF chose Lake Highlands due to the high population density of the community, their pre-existing relationships with community providers, and an existing postive reputation with families.
152
DEMOGRAPHICS OF THE PROTOTYPE POPULATION FAMILY PARTICIPATION
AGE
FAMILY MAKE-UP Range: 3 months to 58 years old
4 single mothers
32 individuals participated
17 children
2 extended family as caregiver
15 adults
3 married or cohabitating partner
6
2
4
1
2
0
0
153
PRIVATE INSURANCE
3
UNINSURED
8
MEDICAID
4
NIGERIAN
10
MULTIRACIAL
5
AFRICAN AMERICAN
INDIVIDUAL HEALTH INSURANCE
HISPANIC OR LATINO/A
FAMILY ETHNIC BACKGROUNDS
NOT DISCLOSED
9 families participated (10 were recruited)
FAMILY WELL-BEING BUSINESS MODEL
THE PROTOTYPE
THE FAMILY WELL-BEING PROTOTYPE The Family Well-Being Prototype was conceptualized as a series of evening sessions that took a group of families on a journey of self reflection and personal growth. At the core of the prototype was a promise to honor families as the experts in their own lives and support them in improving their family well-being however they saw fit. To this end, families worked with a dedicated personal Navigator who helped them articulate and prioritize their goals and match them with customized resources. As families and program staff progressed through the prototype, BIF designers observed the experience to make incremental improvements to help it achieve the desired outcomes. This process of refinement allowed designers to identify both the core components necessary for delivering a successful experience and how these components came together as capabilities to achieve desired outcomes.
154
155
FAMILY WELL-BEING BUSINESS MODEL
156
157
[PICTURE]
158
CORE COMPONENTS
Core components are the essential pieces needed to create a valuable experience for users. Navigator Navigators were the primary point of contact and consistent support throughout family’s experience within the prototype. The Navigator was a dependable figure in the family’s life who provided a space for families to articulate their aspirations and translate these into actionable goals. Navigators established trusted relationships with families, helped them establish and act on their goals, and acted as guides to help families connect to relevant program services and resources. Facilitator The Facilitator was responsible for the overall user experience during the Prototype, making sure the experience was consistently valuable and frictionless for the families. Their three main tasks were to observe, synthesize, and implement. The Facilitator’s observations of individual’s overall experience of the prototype was used to identify opportunities for improvements. These improvements were then implemented. This process of refinement continued through the duration of the prototype to improve the user’s experience. Liaison The Liaison streamlined the process of finding resources for families by getting in direct contact with them, learning about what they specifically do, and verifying information. The Liaison communicated resource options to Navigators who worked with families to select the appropriate ones. Once a selection had been made, the Liaison secured these services for families. They were careful to select resources that would uphold the integrity of the model by honoring families as the experts and formed new partnerships as families’ goals evolved. Liaisons also formed a nexus of knowledge that provided actionable feedback to partners, navigators, and facilitators allowing them to better serve families.
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FAMILY WELL-BEING BUSINESS MODEL
CORE COMPONENTS Subject Matter Experts Throughout the course of the prototype, the Facilitators and Navigators worked together to identify areas of interest shared among families. These interest areas were either a strategy many individuals wanted to learn more about, such as interpersonal communication, or a specific area of assistance that could be addressed through a customized question and answer session (e.g., one session focused on financial planning). The Facilitators and Liaison then worked to locate a local Subject Matter Expert within these areas and invited them to attend a Community Night. Goal Setting Goal setting was a key skill that families learned during the prototype. These goals were grounded in their dreams and provided the families with achievable steps to enable their journey of self reflection and personal growth. Setting goals provided families with the motivation and hope that the changes they made in their lives were in service of a better future.
160
Access to Resources Families were able to learn about the variety of resources available to them and choose ones from a customized selection based on their goals. The Liaison and Navigator worked together to research resources and helped the families make the initial introduction when necessary. The resources were a new opportunity for families to expand their knowledge and take actionable steps to achieve their goals. Supportive Environment The prototype had a built environment that supported the conditions to develop quality relationships at a family’s own pace and provide a space for self-reflection and selfactualization. The space was visually appealing, nonhierarchical and was a comfortable place for self-expression. Families enjoyed coming to the space because they were welcomed into a supportive community of people with a common focus on improving their family’s well-being.
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FAMILY WELL-BEING BUSINESS MODEL
PROTOTYPE STRUCTURE The prototype was tested over the course of 15 weeks with a group of 10 families. Every two weeks, a group of families came either on Tuesday or Wednesday nights to a welcoming six-room suite. There they engaged in a series of activities with the support of the prototype team comprised of the Facilitators, Navigators, Liaison and Subject Matter Experts. The first two weeks of the prototype were dedicated to onboarding families and establishing rapport between Families and their personal Navigator. The Welcome Phase occurred in the first week. During this time families were introduced to each other and the prototype staff. Families met privately with their Navigators and got to know each other through an informal discussion about dreams. The second week was dedicated to initial Goal Setting. In this session, the family met with their Navigator, both as a group and individually, to discuss their personal goals. Together, Navigators and individuals began breaking these goals into actionable steps and identifying potential resources to help accomplish these goals.
162
The subsequent 12 weeks were divided into three recurring phases comprised of Work Weeks, Community Nights, and Reflection Sessions. Work Weeks were weeks without a group session during which the families continued to pursue their goals on their own supported remotely by phone check-ins with the Navigators. Community Nights were a time for all families to meet together to go in depth with Subject Matter Experts on a series of topics. These topics were determined beforehand through Navigator feedback and a family survey. At the Community Night sessions individuals also had the option to meet with their Navigators or work together with members of other families on goal setting. At Reflection Sessions, individuals met privately with their Navigator to discuss the progress on their goals and how their experience had been with their chosen resources. At this time, goals were either refined, expanded upon, or new ones were articulated. Similarly, individuals decided whether they wanted to continue with their resources or to select new ones. By the end of the 15 weeks, families had been through three cycles of setting, pursuing, and reflecting on goals. They had also expanded their support systems by forming relationships with other families, program staff, and connection to resources. 163
FAMILY WELL-BEING BUSINESS MODEL
WEEK PHASE
STRUCTURE MONDAY
TUESDAY
ACTIVITIES WESDNESDAY
1
WELCOME
• •
Introductions Dreams & Family Well-Being Survey
2
GOAL SETTING A
• •
Individual Meetings Goal Setting
3
GOAL SETTING B
• •
Individual Meetings Goal Setting
4
WORK WEEK
• •
Tracking Progress Navigator Check-Ins
5
COMMUNITY NIGHT
• •
Support Groups Family-Led Program Development
6
WORK WEEK
• •
Tracking Progress Navigator Check-Ins
7
REFLECTION
• • •
Individual Meetings Reviewing of Progress Iteration of Goals
8-15
REPEAT
REPEAT THE PROCESS FROM WEEKS 4-7 TWO MORE TIMES
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CAPABILITIES OF THE MODEL
The capabilities of the model fall into three areas: Establish and Deliver Brand Promise Catalyzing Support Systems Setting the Stage for the Experience
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HOW TO READ THIS SECTION: CAPABILITY NAME
A CAPABILITY IS AN OUTCOME ACHIEVED THROUGH PROCESSES THAT USE PEOPLE, TOOLS, AND SIGNALS.
Why It’s Important
Prototype as Precedent
This section explains the essence of the
This section details how these capabilities were delivered during the
capability at a high level.
Family Well-Being Prototype. Keep in mind these are only examples. There are many other ways to achieve the desired outcome. Process: Ways in which that capability is achieved. Processes involve some combination of tools, people, and signals. Tools: Objects, technologies, or devices that are used for a particular function. People: The roles necessary to deliver this capability.
Signals: Signs that help to indicate the important message of the capability.
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES
ESTABLISH AND DELIVER BRAND PROMISE Resonate with user’s already existing desire for change
Create association with known entity that user considers trustworthy
Ensure user’s perception of brand promise and required commitment is aligned with model’s offering
Set strategic tone of interaction
Offer guaranteed value and create the conditions for user generated value
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RESONATE WITH USER’S ALREADY EXISTING DESIRE FOR CHANGE Why It’s Important
Prototype as Precedent
All users have some aspect of their lives
Process:
they want to make change in, either
Consistency in messaging
personally or for those close to them. The brand’s messaging should trigger this already present desire. This can be achieved by emphasizing that the user gets to set their own goals and choose their own resources. By articulating this
• All written or digital materials messaging clearly articulated promise that resonated with individual’s desires: “You get to choose resources for goals you set.”
• All written or digital materials and all representatives of the prototype were aligned in messaging. Tools:
messaging across all materials, users and value in the context of their lives.
• Recruiting Flyer • Recruiting Website • Facilitator Contact Information (phone & email)
As a result, they will be more likely to
People:
take a chance on trying the brand.
• Facilitator • Navigator
can easily identify the brand’s relevance
Signals:
• Information layout was well designed, language was easy to understand, and materials were actionable
• Facilitator’s name, phone number and email were provided for individuals to find out more information
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // ESTABLISH & DELIVER BRAND PROMISE
CREATE ASSOCIATION WITH KNOWN ENTITY THAT USER CONSIDERS TRUSTWORTHY Why It’s Important
Prototype as Precedent
Leveraging associations with an already
Process:
familiar figure in the user’s life can
Leveraging existing brand reputation
help motivate them to sacrifice their personal time and take a chance on a new offering. This figure can take the form of a friend, a community leader, or an institution with a good reputation.
• The prototype was offered as a program through Children’s Health and BIF. Both entities were already trusted by families and known for quality programming.
• Community organizations, such as the UT Southwestern’s Center for Children and Families and Kids U, referred families who were already using their services and who they believed would be open to and benefit from the prototype. Tools:
• Trusted Entities’ Logo (placed on Recruitment Flyer & Website)
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Process: Leveraging existing social networks
• Community leaders and families who had already worked with Children’s Health or BIF helped recruit other families. Tools:
• Referral Bonus People:
• Community Leaders • Families
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // ESTABLISH & DELIVER BRAND PROMISE
ENSURE USER’S PERCEPTION OF BRAND PROMISE AND REQUIRED COMMITMENTIS ALIGNED WITH MODEL’S OFFERING Why It’s Important For the model to have a successful impact on users it requires that they are
Prototype as Precedent Process: Two stage sign-up process
not only willing to try a new offering, but are also serious about committing to
• The recruitment flyer and website required families to either call or email
the entire timeline of the engagement.
Facilitator for further information. • During phone call or by email Facilitator explained prototype in detail, how it differentiated from other social service offerings, and made sure the family fully understood, and was comfortable with, the commitment. They asked families to confirm their understanding. • Facilitator was available for further communication to answer any questions.
Ensuring all users fully understand the scope of activities they are signing up for, as well as all time commitments, is a key step in laying the foundation for trust. This alignment is essential because users may experience
Tools:
unexpected activities or time
• • • • •
commitments as unpleasant surprises or perceive them as intentionally hidden costs, thus comprimising all trust building up to that point.
Family Recruitment Phone Call/Email Family Intake Survey Recruiting Flyer Recruiting Website Facilitator Contact Information (phone and email)
People:
• Facilitator
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Process: Ensure integrity of messaging by establishing community contacts
• Facilitator traveled to key gatherings and locations within the community to speak directly with families, community-based organizations, and community leaders.
• Once contacts had been established within the community, word-ofmouth helped to recruit more families. People:
• Facilitator • Families • Community Leaders
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // ESTABLISH & DELIVER BRAND PROMISE
SET STRATEGIC TONE OF INTERACTION Why It’s Important
Prototype as Precedent
The first interaction with the new model’s
Process:
offering is crucial for both fulfilling user’s
Program introduction by Facilitator
initial expectations, which helps build trust, and establishing the tone that will impact all future interactions. There is a stigma associated with needing to access social services. In order to counteract this and enable users to fully engage, the new model must be careful which part of the user’s identity is activated during initial contact. Rather than feeling the stigma of seeking help,
• Facilitator led families and Navigators in the Well-Being Visioning Activity to validate and ground individuals in their personal concepts of family well-being.
• Facilitator emphasized user’s role: “You are here because you want to improve the well-being of your family. You are the expert in your life and the goals you see as important are the ones we are here to support.”
• Facilitator also emphasized the role of the families in supporting each other in a respectful manner and helping to improve the experience through feedback. Tools:
the user needs to see themselves as
• Well-Being Visioning Activity • Family Welcome Packet • Feedback Forms
co-creator of their own experience and as a part of a community of individuals seeking to improve their family’s well-
People:
being.
• Facilitator
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Process:
Process:
Consistency in tone of
Families were welcomed into the prototype
interaction and messaging
• Families met other families who were sharing the same
• All prototype staff, program materials, and associated
experience together.
vendors adhered to consistent styles of interaction and
• Facilitators showed gratitude for families presence and
messaging that reinforced and supported intended
thanked them for having the courage to make change
users’ identity.
in their lives..
• Facilitator and Navigators reiterated ground rules of
• Materials were written in a language level that all
interaction throughout program.
families could comprehend.
• Liaison developed relationships with vendors providing
• Program staff matched the dress of the families to
resources to families and strategically chose ones
avoid a sense of hierarchy.
whose ethos was aligned with prototype.
Tools:
Tools:
• Family Welcome Packet • Program Materials
• Navigator Manual (with guidelines for interaction)
• Role Playing Training • Debrief Meetings
People:
People:
Signals:
• Facilitator
• Facilitator • Liaison
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Program was branded as family-oriented. Other families were present. Program staff was dressed casually. Interior design was calming and fun.
FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // ESTABLISH & DELIVER BRAND PROMISE
OFFER GUARANTEED VALUE AND CREATE THE CONDITIONS FOR USER-GENERATED VALUE Why It’s Important Many of the processes of the new model rely on recurring interactions that help build and deepen relationships. If users attend sporadically these relationships will fail to cohere. To ensure consistent, sustained engagement, users need to know that it’s always worth their time to come to the sessions. This can be accomplished by having two types of value associated with the model’s offering: user-generated value and guaranteed value.
User-generated value is created as users participate in the activities of the model’s offering, leading to intrinsic movtivation. Guaranteed value is tangible value that is consistently present at every session and acts as buffers for times when user generated value is less tangible. Thereby, providing extrinsic motivation.
These two types of value are necessary because at its core the model is supporting a process of personal growth. While engaging in certain activities, such as intense personal conversations, goal-setting, or attempting to pursue challenging goals, users have the potential to feel dissatisfied and frustrated at times. Through continued engagement and catalyzing support systems, the user generated value is solidified and eventually eclipses the guaranteed value in importance. When this occurs, users begin to experience intrinsic motivation to continue the process of personal growth.
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Examples of how the prototype offered GUARANTEED VALUE:
Examples of how the prototype created USER-GENERATED VALUE: Provided experiential opportunities for families to learn strategies for:
Provided tangible value at every session • Healthy Family Dinners • Childcare • Raffle Prizes
• • • •
Self-Advocacy Family Communication Critical Self Reflection SMART Goal-Setting
Responsiveness and follow through at every session. • By being responsive to conversations, questions, and requests from session to session, and always following through on promises, families learned they could rely on the Facilitators and Navigators to ensure that in each session there was a sense of progress.
The conditions for user-generated value were
Demonstrated continual effort
Catalyzing Support Systems provided access to:
primarialy through capabilites within the other two areas:
• Navigator as:
• The Liaison and Navigators worked between sessions to
• Thought Partner • Motivator • Accountability Figure • Advocate
ensure each time Navigators met with families they would have new resource options to present to them, updates on resources they were working on accessing, or checkins to ensure the family was satisfied with their current resources. Families were never told: “Sorry, there’s nothing we can find.”
• • • • •
Tailored acitives to families needs and growth trajectory
• After each session, the Facilitators and Navigators had a debreif meeting. Facilitators then worked to develop new activities that built upon the previous session in a logical manner. As a result, families felt a sense of growth and acitivies weren’t repetitive.
Peer Network Opportunities for Peer Learning Exposure to Diverse Role Models Specialized Knowledge Subject Matter Experts
Setting the Stage for the Experience provided access to: • Time and Space for Self Reflection • Quality Playtime
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES
CATALYZING SUPPORT SYSTEMS Build Trust
Model the process of building healthy supports systems
Create an environment rich in connections
Maintain momentum by modeling methods of resilience and by sustaining hope
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BUILD TRUST Why It’s Important
Prototype as Precedent
Trust is a feeling that is built over time
Process:
as a result of an accumulation of trust-
Families felt safe because Navigators kept their
building actions. Three primary trustbuilding actions result in people feeling safe: keeping each family member’s confidence, expressing empathy rather than judgment, and delivering on
information private • One-on-one meetings and whole family meetings created opportunities for private interactions to occur.
• Navigators demonstrated their trustworthiness by not sharing individual’s personal information with anyone else in the family. Tools:
promises. Trusting relationships create
• • • •
a context for vulnerability to occur safely without negative consequences, enabling learning and personal exploration to take place.
Private Meeting Rooms Encrypted HIPAA Compliant Communication Platform Dedicated Individual and Family Binders Phone Calls and Text Messaging
People:
• Navigator
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Process:
Process:
Navigators expressed empathy
Promises were kept, demonstrating
rather than judgment
dependability and consistency
• Navigators first listened to families’ hopes, self-
• Navigators made gestures signaling dependability, like
disclosure.
ending the sessions at the agreed upon time.
• Navigators asked questions rather than evaluating
• Navigators arrived on time to ensure that they always
choices.
met obligations made to the families.
• Navigators also shared their hopes and dreams. This
• Navigators delivered contact information regarding
allowed families to feel a sense of emotional equity and
resources and social services as promised.
helped drive relational development.
Tools:
• Clocks • Navigator Manual
Tools:
• Motivational Interviewing Training • Defining Your Dreams Worksheet/
People:
Drawing Activity
• Navigator • Liaison • Facilitator
People:
• Navigator
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // CATALYZING SUPPORT SYSTEMS
MODEL THE PROCESS OF BUILDING HEALTHY SUPPORT SYSTEMS Why It’s Important The ability to reach goals in life is heavily impacted by the interpersonal support systems and institutional support systems that surround individuals. INTERPERSONAL SUPPORT SYSTEMS Small social contexts (e.g., family and friends, as well as larger systems) can create healthy or unhealthy environments, which in turn impact the social determinants that affect people’s health and well-being. The ability to advocate for support is a strategic skill to develop. Additionally, being exposed to what a supportive relationship feels like sets a precedent for future relationships. The combination of these two experiences enables users to become better able to advocate for the type of relationships that help them reach their goals. INSTITUTIONAL SUPPORT SYSTEMS Even with a healthy interpersonal support system, the user must also build and maintain an institutional support system involving organizations and social services. This support system is key in allowing them to access new resources as their life circumstances change and goals evolve. However, users do not always have the literacy or experience to navigate these relationships. Thus it is benefitial to build this skill with the help of a trusted advocate.
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BUILDING INTERPERSONAL SUPPORT SYSTEMS
BUILDING INSTITUIONAL SUPPORT SYSTEMS
Process:
Process:
Reaching personal goals requires
Help prepare individuals by talking through
self-understanding
the steps they might encounter
• Navigators asked family members reflective questions about
• Role playing with their Navigator helped individuals feel
their goals. Individuals, in turn, learned to ask these same
more confident and preemptively answered many
questions of themselves when setting goals and were able to
questions that could become barriers.
apply the SMART goal process to different parts of their life. Tools:
People:
• • • •
• Navigator
SMART Goal Worksheet Private Meeting Rooms
Tools:
People:
• Private Meeting Rooms • Public Communal
• Navigator
Space
Motivational Interviewing Training
• Phone Calls and
Family Well-Being Survey Results
Text Messaging
Process:
Process:
Model supportive relationships
Help prepare individuals by talking through the steps they might encounter • This helped circumvent stigma for families asking for help
• Navigator and individual interactions modeled what supportive interpersonal relationships looked like; over time,
by offering it proactively and prompted family members
they observed similar patterns emerging among family
to ask questions that allowed them to move through the
members and between different households.
process of accessing resources more efficiently.
Tools:
People:
Tools:
People:
• Family Support Pledge • Phone Calls and
• Navigator
• Family Support Pledge • Phone Calls and
• Navigator • Liasion
Text Messaging
Text Messaging
• Private Meeting Rooms
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CREATE AN ENVIRONMENT RICH IN CONNECTIONS Why It’s Important The model develops mutiple levels of social penetration for the user by incorporating different combinations of interactions. These include tight social connections as well as loose social connections. This multi-layered approach creates an environment rich in social capital, connected knowledge, and evokes a sense of belonging.
Prototype as Precedent Process: Program built opportunities for deeper relationships to develop
• To built rapport, sessions included informal activities like conversations exploring people’s dreams and drawing along with the kids. • Deeper interpersonal relationships supported a sense of safety and belonging that enabled exploration and growth. • Multiple meetings over a period of weeks allowed the families and Navigators time to develop a deeper level of interpersonal relationship. • Including all family members in the sessions brought in deeper relationships that already existed in inter-familial setting (e.g., mother/ daughter and husband/wife). Tools: • Dedicated Onboarding Period (three consecutive weeks) • Informal Activities (focused on first getting to know family rather than pushing program agenda) • Defining Your Dreams Worksheet/Drawing Activity People: • Navigator
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Process:
Process:
Families sit together at communal tables and
Subject-Matter Experts represent
have family style dinner together
loose connections
• Subject-Matter Experts were representatives from
• This created informal contexts for different families to share knowledge and build connections. The result of recurring causal interactions is the creation of new relationships, a strong sense of belonging among participants, and a platform for the sharing and the exchange of ideas through personal storytelling. Tools: • Large Room (accommodates 3-6 families) • Communal Tables (with seating for more than one family) • Same families attend same nights over course of program • Family Style Dinner (shared dishes that require interaction to access) People: • Families • Navigator
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resources in which families expressed the most interest. They attended the Community Night sessions creating an additional social layer that enriched the environment and set the stage to grow social capital, connect knowledge, and democratize access to specialized knowledge and resources. Tools: • Navigator Notes • Interviews • Family Interest Survey (used to identify appropriate experts for adults and youth) People: • Navigator • Subject Matter Expert • Liaison
FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // CATALYZING SUPPORT SYSTEMS
MAINTAIN MOMENTUM BY SUSTAINING HOPE Why It’s Important In order for users to carry forward on their own with independent systems of support, it’s best to provide an initial burst of momentum and teach strategies for how to mitigate the ups and downs inherent in a process of self-discovery and growth. Creating a social and mental framework to process
Prototype as Precedent Process: Navigators recognize and acknowledge success and progress
• When roadblocks arose it was vital to maintain a sense of hope. Navigators focused on time-bound, achievable actions and tasks within the participants’ sphere of influence. Navigators celebrated these actions as successful steps that progressed families towards their final outcomes/goals. Tools: • SMART Goal Worksheet (Adult and Kid versions) • Family Well-Being Survey and Results • Well-Being Visioning Activity
disappointments is an essential element to maintain engagement. Additionally, the process of setting goals needs to be focused on areas within the user’s
People: • Navigator
control, asking: “what can you do today to make tomorrow better.” This focus will help users sustain a sense of hope during the process.
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Process: Navigators expressed gratitude
• Navigators verbally acknowledged and appreciated families taking the time to show up and to make changes in their lives. Tools: • Private Meeting Rooms • Navigator Training People: • Navigator
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES
SETTING THE STAGE FOR THE EXPERIENCE Create an offering that is accessible, consistent, and flexible
Provide a new and neutral ground where users feel they belong
Use the built environment to facilitate the core interactions of the experience
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PHOTO
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // SETTING THE STAGE
CREATE AN OFFERING THAT IS ACCESSIBLE, CONSISTENT, AND FLEXIBLE Why It’s Important
Prototype as Precedent Process: Accessibility - Evaluate forms of transportation
Users are more likely to participate in the model if it is convenient for them. If it is inconvenient, it will add extra stress to users’ lives and decrease the value of the model. Convenience factors include: the accessibility of
• Families use different modes of transportation—bus, taxi, car. Proximity to all these modes was considered when choosing a location. • Physical location was close to a bus route and had a free parking lot.
the physical location, date and time of
Process: Accessibility - Locate the experience within the community
the meeting, and preferred methods of communication. The model must be responsive across these dimensions to accommodate a variety of lifestyles and unplanned events that inevitably occur in daily life. Taking into account these
• Prototype was nearby where families spend a majority of their time. • Locations of the all family members were considered (e.g., home, work, and school). Tools: • Map and Directions
factors will substantially increase user willingness to participate.
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Process:
Process:
Consistent meeting times and location
Flexibility - Provided alternate & additional opportunities to meet with their Navigator
• Families participated in the prototype on specific days
• Families who could not meet on their scheduled night
and times of the week. • Meetings provided a routine and consistency that supported families in making changes in their own lives.
could meet on another night if their Navigator was available. • If individuals preferred face-to-face communication, they could meet with their Navigator in person outside of the scheduled meeting times. • Flexibility in these meeting times helped increase the participation rate for families who experienced unexpected schedule changes, but still wanted to attend the sessions.
People: • Navigator Process: Flexibility - Customize the experience to reflect user preferences
Tools: • 24-hour accessible space
• Families were asked what meetings times worked best for their family, as well as their preferred method and frequency of communication.
People: • Navigator
Tools: • Program Materials - personalized rather than generic with relevant information specific to each family People: • Facilitator • Navigator 191
FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // SETTING THE STAGE
PROVIDE A NEW AND NEUTRAL GROUND WHERE USERS FEEL THEY BELONG Why It’s Important The space must be inviting, visually appealing, and free from any negative associations. A welcoming atmosphere helps users overcome initial apprehensions and supports a sense of belonging and personal connection to the model. This new environment helps
Prototype as Precedent Process: Prototype was in a new location
• New office space that the families had never been before. • Not located in an educational, religious or medical institution. • No existing expectations of how people should have acted or what the space was supposed to be. • Families developed their own ideas about what well-being meant to them .
users activate a new identity, one that
Tools: • Office Space • Furniture • Map and Directions • Well-Being Visioning Activity
embodies taking steps to reach their goals and make changes in their lives. The space itself can function as a ritual by inviting users to enter with a clean slate and begin a new phase of personal growth.
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Process:
Process:
Everyone ate dinner together as part
Provide co-creative areas
of the prototype
• Eating together created a sense of community. • Families shared time together which made them feel
• Children played and drew pictures, which Facilitators hung on the wall. • Families contributed to a space that they had actively created.
connected and welcomed into the prototype. Tools: • Dining tables that seat multiple families
Tools: • Paper • Craft Supplies • Drawing Tools People: • Facilitator
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // SETTING THE STAGE
USE THE BUILT ENVIRONMENT TO FACILITATE THE CORE INTERACTIONS OF THE EXPERIENCE Why It’s Important The environment must be built in a way that supports users interacting in productive and meaningful ways. Certain attributes need to be adhered to create the conditions for intended outcomes of the model.
Prototype as Precedent Process: Model was responsive to family feedback and facilitator observations
• Facilitators observed how families and the delivery team behaved in the space. • The environment was changed to support emergent behaviors within the space. • Families were asked to select topics they wanted expertise on. People: • Facilitator • Subject Matter Expert Tools: • Direct Observation • Feedback Forms • Fieldnotes • Debrief Meeting
Process: The prototype adhered to the attributes of the space.
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Prototype Suite Floor Plan PRIVATE MEETING ROOM
KITCHEN
DINING ROOM
COMMUNAL PLAY SPACE
PRIVATE MEETING ROOM
OFFICE
PRIVATE MEETING ROOM
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FAMILY WELL-BEING BUSINESS MODEL // CAPABILITIES // SETTING THE STAGE
ATTRIBUTES OF THE SPACE Display a non-hierarchical environment to signal that everyone’s voice is valuable, equal, and worthy of being heard • All family members and their Navigator faced each other in meetings so they were in a comfortable position to talk openly as a family. • The space had elements indicating equal levels of power between the families and the program staff. • No one had an advantageous physical position by being in a more comfortable or higher chair than someone else. Tools: • Round Tables • Same Type of Chairs
• Similar Sized Rooms • Toys and Games
Appeal to visual senses • The space had fun and inviting colors with mood lighting, which helped create a sense of cheerfulness for families. Tools: • Lighting • Color scheme • Accent Rugs
• Pictures • Toys and Games
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Promote a sense of belonging and community • Families felt like they were part of a larger group of people focused on the same outcome. • Designed to appeal to all members of the family. • Rapport was built among families over dinner and in informal areas of the environment.
Design in a meaningful way demonstrates respect • The interior design was thoughtfully crafted to create a sophisticated and comfortable coffee shop feel. • The environment was kept clean and demonstrated that the program staff cared about the space and thus the people who spent time in it.
Tools: • Communal Dining • Coffee Tables • Toys and Games Table • Couches
Tools: • Lighting • Pictures
Provide public and private areas • Private rooms had closed doors to allow deep conversation and productive self-reflection to occur between Navigators and individuals. • Public areas in the space were accessible to anyone. • Large windows between rooms allowed parents to see their children playing with others in the public spaces while they had private conversations. Tools: • Windows • Private Meeting Rooms • Doors • Public Communal Space
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FAMILY WELL-BEING BUSINESS MODEL
DATA
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NEW MEASUREMENT MODELS Business model innovation efforts can’t be measured and assessed by the same economics or metrics that are used to assess efforts to improve the performance of the existing business model. To that end, CHST and BIF had to design entirely new metrics to asses the exploration of the new business model, including methods of evaluating family well-being. The latter was addressed through the design of the “Family Well-Being Quotient” - a rubric and algorithm for assessing and quantifying families’ positions across the Elements of Well-Being. To assess the whole model, the team iterated on a Kirkpatrick Evaluation Model asking: • Is it a good experience for participants? • Does it improve the confidence of the participants to act in service of their well-being? • Did behaviors change, and did participants take new steps in service of their well-being? • Did well-being change, as measured through the Family Well-Being Quotient? What follows is a summary of the findings:
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FAMILY WELL-BEING BUSINESS MODEL
LEARNINGS & INSIGHTS
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205
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Having a family progam, with both group and individual aspects, tapped into a powerful force for motivation. People have a desire to support those they love in becoming better versions of themselves. Within a family, each individual had one thing they were willing to work towards to improve or change. Individuals will pursue these goals, if given the opportunity to choose them personally. Each individual’s goals need to be grounded in what gives them a sense of fulfillment in their lives in order for the value of the program to be personally relevant. Trusting individuals to choose their own goals, rather than telling them what to work on, is crucial to their participation and engagement. It is important to trust the individual as the expert in their own experience, and to respect the boundaries of what families choose to share about their lives. Often, one family member leads other members, which influences their participation and engagement. Other family members will also participate to support each other and because they see areas ripe for change, both in themselves and in each other. Individuals will articulate their own needs and goals. BUT they need to be given the space, time, opportunity, and support to do so.
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FAMILY WELL-BEING BUSINESS MODEL // LEARNING & INSIGHTS
The delivery model is dependent on establishing and building relationships. The model is dependent on moving from transactions to relationships. At the heart of the value proposition is a promise to act in partnership with families. At its core, this is a promise to be consistent, authentic, and trustworthy. Belonging, trust, and engagement are established using different levels of relationships. The Navigator relationship had the most depth, since they acted as both a confidant and advocate for the individual. The Facilitator created consistency of delivery, which helped build institutional and brand trust. Other families helped individuals see they were not the only ones who needed help and provided a network of peer support. Subject Matter Experts brought in outside knowledge, and families trusted them because of the established relationship with the Navigators and Facilitators. Individuals will sign up for the program. BUT their sustained participation and engagement is dependent on the degree to which various roles can establish and build trusted and consistent relationships.
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PICTURE
209
PICTURE
210
Sustained engagement is the outcome of a sense of community comprised of familiar and unfamiliar participants. Families thrived in a non-judgmental, non-hierarchical environment. Here, they recognized that they were united around the common goal of supporting family wellbeing. Sharing real experiences gave participants concrete and contextually relevant examples and success stories. This peer learning inspired and motivated families to create change in their own lives. Balancing familiar and unfamiliar relationships created an environment that encouraged self-exploration, as well as sharing and reflection. Enabling families to invite others in their network, while the program staff recruited diverse participants, co-created the “right� balance of participants. Familiar faces gave participants a sense of safety and support. BUT unfamiliar faces encouraged open, exploratory conversations.
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Next Steps:
CONTINUING TO SCALE THE FAMILY WELL-BEING MODEL “You want to improve your family’s well-being. We want to help” The Family Well-Being Model, when taken to future degrees of scale, has the potential to positively impact the market position and offering,of Children’s Health. It can be adopted by the HMO to deliver well-being to newly enrolled populations and change how the health system engages people in primary care or in the treatment of chronic conditions. To do so, it will require integrating the model into a variety of places, with a clear and repeatable process to:
• •
Align existing capabilities to the new value proposition Extricate capabilities from their existing programmatic silos, and re-organize them to deliver value in new ways that will better serve populations (rather than disease groups)
•
Train teams to deliver on the attributes of the model
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CONTINUING TO SCALE // THE TEAM INNOVATION PROCESS
TEAM INNOVATION PROCESS
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WHY IT’S IMPORTANT Teams within Population Health are integral to transforming Children’s Health’s offerings, and must engage in an inter-departmental Team Innovation Process that will:
•
Establish a department-wide process for aligning team capabilities to the family well-being mission.
•
Create a work item inventory that can provide value for families, informed by and prioritized around family experience.
•
Involve families and community stakeholders in every stage of the process, so that existing capabilities can be leveraged.
•
Facilitate transparency and collaboration among cross-functional, multidisciplinary teams.
Guiding questions for teams undertaking this process include: 1. How might we tap into the individual and shared goals of families to support their positive lifestyle changes? 2. How might we organize resources, including information and services, so they are meaningful and relevant to families? 3. How might we integrate offerings into the places that families live, work, and play so that they are easily accessible?
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CONTINUING TO SCALE // THE TEAM INNOVATION PROCESS
METHODOLOGY This work is grounded in design thinking and agile methodologies. Design thinking is a process for solving problems by identifying opportunities, generating innovative ideas, and accelerating change through experimentation. It enables change by understanding the experiences of people being served and challenging the status quo. Agile methodologies are true to their name – they enable multi-disciplinary, cross-functional teams to move quickly and transparently, adapting and collaborating with each other as they work to achieve established goals. Scrum is a successful agile framework that fosters tight-knit collaboration among teams and divides complicated jobs into short, manageable phases of work with frequent opportunity for reassessment and adaptation. Before any collaborative efforts can take place, individuals intending to undertake the process spend time developing as a team to defining their vision, goals, and work process. Teams then explore issues facing the families they serve, developing a deep empathetic understanding of their needs and desires. Looking through this lens of family experiences, teams reflect on what they have learned and imagine services or projects that meet families’ needs, capturing these items in a comprehensive Backlog. With this Backlog in place, teams play, putting their ideas into action through a Sprint. At the end of the Sprint, teams reflect on and improve their own process, and share their outputs with stakeholders for feedback. Teams then transform their work by communicating their success and challenges to management and implementing and assessing their outputs.
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PROCESS OVERVIEW Team Development and Scrum Training
STAGE
ACTIVITIES
Define vision, goals, teams & process
Team Development; Scrum Training
Team members get to know one another, share assets and knowledge, and seek to understand their collective capabilities. The team goes over background and receives an overview of the team innovation process. The team discusses focus areas to work on during the
Explore & seek an understanding of families
Family Exploration
Reflect on the needs and desires of families.
Family Exploration (cont.); Backlog Creation
Imagine ideas to meet families’ needs & desires.
Backlog Creation (cont.); Sprint Planning
Play by putting ideas into action & receiving feedback
Daily Scrum; Sprint Review; Sprint Retrospective; Backlog Refinement
Transform by communicating & implementing outputs
Communicate, Implement, and Assess Outputs
Sprint and sets their schedule.
Family Exploration Family exploration activities allow teams to touch base with families they serve and learn about their needs, so they can better meet them. These activities may include interviews, feedback activities, and journey mapping.
Backlog Creation During Backlog Creation, the team makes a comprehensive list of all work items that could be undertaken to provide value for families. The Backlog is comprised of items that are part of the team’s usual workflow and new items that are brainstormed as opportunities to collaborate to meet family needs. The team prioritizes the items based on positive impact for families and uses the Backlog to drive the workflow of all future Sprints.
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4
Sprint Planning
Sprint Retrospective
At the Sprint Planning Meeting, the team sets
The Sprint Retrospective is an opportunity for
their goal for a Sprint and chooses backlog items
the entire team to reflect and create a plan for
to accomplish that goal, thinking about what is
improvements to be enacted during the team’s next
of highest priority and feasibility within the set
Sprint. The team discusses what worked and didn’t
timeframe. For each backlog item, the team solidifies
work during the Sprint. This is an opportunity to refine
acceptance criteria – outcomes that need to be
team norms, roles and rules, and to discuss next steps
achieved in order for an item to be considered
for Sprint planning.
finished, and sets their definition of done – a quality assessment protocol. The team uses the selected
Backlog Refinement
Sprint backlog items to generate a preliminary set
The team refines the Backlog using input from
of tasks to complete during the Sprint, which can be
their past Sprint experience by adding any new
added to and revised as the Sprint is underway.
items, assessing how long tasks took to complete, and determining whether the team under- or overestimated the Sprint workload to improve future
Sprint Review
planning efforts. The team re-prioritizes the Backlog
A Sprint Review meeting is held at the end of each
and breaks down Backlog items into manageable ones
Sprint to demonstrate the outputs created by the
if needed. The team can identify what to work on in a
team to stakeholders. During the meeting, the team
future Sprint and when to start another one.
collectively reviews the Sprint goal and Sprint Backlog items, demonstrates the outputs created, decides
Communicate, Implement and Assess Outputs
which items are done according to the definition
Teams use common meetings and platforms to inform
of done, and solicits feedback from stakeholders,
staff about their progress using the Scrum process.
creating and altering Backlog items based on
Teams develop a plan for putting Sprint outputs into
recommendations.
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CONTINUING TO SCALE // THE TEAM INNOVATION PROCESS
RECOMMENDED PROCESS TIMELINE Pre-Sprint (<1 month)
During Sprint (2-4 weeks)
Family Exploration Activities Team Development & Training
Sprint Planning Backlog Creation
Post-Sprint (2-4 weeks)
Sprint Retrospective
Sprint Review Backlog Refinement
Implementation (Ongoing)
Communicate, Implement, & Assess Outputs
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Daily Scrums
Process Roles There are three roles on a Scrum team: Scrum Masters help the team understand and enact the Scrum process effectively. They facilitate meetings, address impediments, and answer procedural questions. Product Owners are key decision-makers on the team, seeking to maximize the value of the teamâ&#x20AC;&#x2122;s outputs for families. They are the voice of alignment, both with family needs and Childrenâ&#x20AC;&#x2122;s strategic vision, throughout the process. Team Members work to complete selected backlog items during a Sprint. They are the voice of feasibility, surfacing logistical barriers and challenges throughout the process These roles work together through a set of defined meetings that help teams to decide on clear, actionable Sprint goals and backlog items to accomplish together during a team-decided Sprint timeframe..
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CONTINUING TO SCALE // LEARNINGS AND INSIGHTS
LEARNINGS & INSIGHTS
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Leadership’s Commitment is Pivotal. Children’s Health leadership should dedicate staff to strategically plan the implementation of the Team Innovation Process throughout the organization. This staff should train Children’s Health employees in the process and evaluate teams’ procedures and effectiveness, sharing learnings throughout the organization. They should also focus on establishing communication channels and procedures so teams are aligned and can work efficiently and transparently toward the value proposition. Teams undertaking the process should be given a clear commitment from leadership and all necessary resources, including dedicated time. When a new team forms, leadership should provide guidance in their Backlog creation and goal formation to ensure alignment with Children’s Health priorities. This feedback helps teams make informed decisions throughout the process. Leadership should also provide feedback on a team’s Sprint outputs, with a view of how they can be implemented within the organization. With the commitment of resources and targeted feedback from leadership, teams are able to function autonomously in service of the Children’s Health vision.
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Teams Need Purposeful Roles. Teams are comprised of individuals who are best apt to tackle a particular problem. Team members should represent different disciplines and levels of work within the organization, and have the bandwidth to fully participate in the process. Scrum Masters must have the skillset to facilitate all activities and the ability to address the teamâ&#x20AC;&#x2122;s logistical impediments with leadership. They do not take on Sprint tasks their role on the team is to take care of all logistical details and guide the team through the process. Product Owners must have a strong sense of their teamâ&#x20AC;&#x2122;s goals and a vision of what the team needs to achieve over the course of a Sprint. They lead the Sprint workflow and answer task-related questions from team members. Team members, particularly Product Owners and Scrum Masters, must be active participants in the process, attending all meetings.
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Teams Need Dedicated Time. The team innovation process takes time. In order for teams to have the greatest impact in their work and to gain expertise in the process, they need significant periods dedicated to learning the process and implementing its workflow. From the beginning, Scrum Masters – with support from Children’s Health leadership – need to carve out time for team training, meetings, and activities, taking into account additional team member workloads, PTO, and seasonal pressures. While planning, it is important for leadership to be realistic and in estimating effort and feasibility, especially during teams’ first Sprints, when they are newly learning the process. After multiple Sprints, teams are able to move together more efficiently.
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Set the Stage with Context and Team Building. Extensive team building and process training is vital before undertaking Sprints. Early team development provides team members with clear expectations, boosts their confidence, and prepares them for undertaking the innovation process. With multidisciplinary teams working together for the first time, additional meetings may be necessary to ensure team members understand each otherâ&#x20AC;&#x2122;s roles and responsibilities within the organization and have a knowledge of their teamâ&#x20AC;&#x2122;s strengths and shared capacity.
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Sprint Planning Involves SMART Goals. Teams should choose goals and backlog items that will create new value for families and utilize existing workflows. The Sprint goal should be dependent on the teamâ&#x20AC;&#x2122;s workload, ability, and identified priorities. Chosen backlog items should allow teams to move forward without external constraints. Tasks should be broken down into manageable pieces of work and be organized in a logical, time-conscious workflow. Utilizing a visual Sprint Backlog board helps team members take ownership of tasks and track their realtime progress once the Sprint starts.
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PICTURE
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CONCLUSION
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The four year partnership between Children’s Health and BIF explored the potential for new business models to effectively engage individuals in their health and proactively address the disconnects of the current health care system. Core this opportunity is serving the entire family, a focus on improving well-being as an avenue to improving health outcomes, and utilizing an empathetic approach. Working in tandem, these factors will facilitate a shift in the center of gravity away from sick care towards a health system that truly supports people’s ability to stay healthy. To understand the practical application of this process, Children’s Health and BIF partnered with families at four different levels: the medically complex family unit, the existing medical home, the design of a new family centered clinic, and the conceptualization and testing of a new business model. An empathetic approach unites the themes found to be key in supporting families across levels: respecting families as the experts in their own experience, catalyzing a support system beyond the individual, and ensuring that services and information are accessible and relevant to everyone. By honoring these three tenets, an empathetic approach builds trust between the family and the provider that deepens over time. This trust sets the stage for a positive feedback loop supporting better relationships, health, and well-being outcomes at the scale of the individual, community, and healthcare system. In turn, the transformation of these nested levels creates a ripple effect that drives systemic change, ultimately increasing the capacity of both the individual to engage in self care and the community to address the social determinants of health. As a result, the burden on the provider decreases through a process that is driven by intrinsic motivation and moves the health system towards the value-add service paradigm of the near future. The Team Innovation Process provides an avenue for Children’s Health to apply the learnings, insights, and capabilities identified in this body of work. This process weds design thinking and agile methodologies. By doing so, it enables change to be driven by an understanding of the experiences of people being served and provides a framework for multi-disciplinary, cross-functional teams to collaborate effectively. This combination of methodologies provides a streamlined process to transform the existing model in service of supporting a comprehensive vision of family well-being. This emerging business model points to an evolving role for a large health system: from being a provider of services to becoming a builder of partnerships. By assuming this mantle, Children’s Health will become a co-creator of well-being, able to support families on a continuing journey. 232
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ACKNOWLEDGEMENTS We would like to acknowledge the amazing people who played key roles in this project: First and foremost, to the 200+ families who played with us. Thank you for sharing your stories, for welcoming us into your homes, for helping us explore your communities, and for participating passionately in our prototypes. You co-created this experience, our learnings, and the final deliverables with us, and for that, we are incredibly grateful. To our friends at in the community who we have worked with over the years, thank you for partnering, helping us recruit families, and enabling us to navigate the great city of Dallas. Thank you to Karla Armendariz, Max Leland, Fernando Rubio, the team at Cucina Allegra, Margaret Owens and her team at Center for Children and Families, Sherrye Willis, and Vicki Taylor. Over the years, we’ve had the distinct pleasure of working with so many staff at Children’s Health. Many thanks to Ray Tsai and his team at Children’s Health Pediatric Group, Rathna Gray, Stacy Henry, Laura Keller, Joshua Malone, Michelle Thomas, Marisa Abbe, Michelle Anguiano, Norma Gonzalez, Eleanor Rivera, Patricia Rodriguez, Doris Hunt, Cheryl McCarver, Amy McGinnis, Jason Wallace, Denise Gomez, Jeremiah Salmon, Alex Reid, Tiffanie Huffmaster, Crystal Tyler, Denita Wade, Sue Schell, Karen Kennedy, Kirsii-Marja Hayes, Brooke Burnside, Jason Isham, Pete Perialis, Pamela Rogers, Doug Sanders, Beth Peters, Lisa Frenkel, Javier Montemayor, Jodi Landon, Teresa Sheffield, Silvia Gallegos, Mayrani Velazquez, Noemi Manriquez, Rose Valdez, Patricia Neus, Suzy Armstrong, Alex Carrasco, Maria Maese, Rebecca Ross, Anneke Johnston, and Pat Winnings. Many many special thanks to our team of project managers and advisors, including Rob Shaum, Shirley Roberts, Michael Samuelson, Dee Eddington, Ted Dack, Jim Purcell, and Saul Kaplan - who guided, advised, and questioned us along the way. Thank you to Jennie Evans, for continuing to champion design thinking and family well-being within Children’s Health. Thank you to Peter Roberts, for the leadership, courage, and audacity to imagine a different business model for healthcare, and for inviting us to partner on this journey.
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CREDITS We are grateful for the advice, support, and effort from past and present members of the Business Innovation Factory team: Tori Drew, Victoria Guck, Chris Hurbs, James Hamar, David Zacher, Leigh Anne Cappello, Karen Jorge, Jessica Floeh, Bridget Landry, Lindsey Messervy, and Kara Sanchez. Finally, we are grateful to all the BIF designers who worked directly on this project. It is a product of their hard work and dedication. Thank you to Crystal Rome, Kaye Evans-Lutterodt, Kay Zagrodny, Sam Kowalczyk, Kirtley Fisher, Taylor Halversen, Jacob Brancasi, Reid Henkel, and Elizabeth MacLaren.
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Ch dren's Medical Center