An Exploration of a Family-Centered Business Model

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:

•

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.

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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.

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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

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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]

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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.

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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.

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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.

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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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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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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

• • • • 175

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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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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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

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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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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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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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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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LEARNINGS & INSIGHTS

204

205

206

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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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:

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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)

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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:

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Establish a department-wide process for aligning team capabilities to the family well-being mission.

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Create a work item inventory that can provide value for families, informed by and prioritized around family experience.

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Involve families and community stakeholders in every stage of the process, so that existing capabilities can be leveraged.

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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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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.

use and evaluating them with relevant measures of success.

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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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CONTINUING TO SCALE // LEARNINGS AND INSIGHTS

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.

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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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