Community Care

Community Cares

Creating a community-effective healthcare service for underserved communities by making primary care more relevant and reflective of community specific realities.

Timeline : July 2021 – December 2021

My Role

Design planning and research, Design strategy, Experience modeling, Implementation plan

Client

Rush University Medical Centre Sue Gin Clinic and The Community Builders(TCB)

Skills

Workshop facilitation, UX design, Service design, Visual Design

Project Type

Workshop facilitation, UX design, Service design, Visual Design

Collaboration

Medical Students, Doctors/ nurses, Community partners, Client partners, Fellow designers

Project domains

Participatory Design, Service Design, Experience Design

Project Background

This project, in collaboration with Rush University Medical Center, Sue Gin Clinic, and The Community Builders (TCB), aimed to develop a future model for effective primary care in Chicago Westside’s Oakley Square. We co-designed with predominantly female residents, dividing the community into three target groups: adults, mothers with children, and teenagers. My team focused on female adult residents, designing a care delivery model that addressed their specific needs.

The Problem

How might we create primary care that communities want and need?

Healthcare in The United States is highly fragmented. Primary care is underutilized, difficult to access, and poorly-perceived by many in the Chicago West Side community.

High utilization rates of Emergency Rooms for non-acute issues is one indicator that residents want and need care, but current primary care offerings are a poor fit.

Why is it a problem?

Healthcare problems often persist within other problems in the system.

In spite of efforts such as – value-based care models, accountable care organizations, and integrated health home models of care – to change the status quo of healthcare delivery, poor health outcomes and health inequities persist, especially in communities with underlying social vulnerabilities. This reality suggests the need for a new approach which is more specific to community needs.

Fixative approaches to care delivery where one size fits all have been inadequate and ineffective

Care delivery systems do not factor in the personalized voices of the community partners who they are trying to impact. Healthcare services function on the paradigms of one size fits all. As a result the innate needs of these communities are remaining unaddressed. Therefore there is a need for clinic operations and care delivery that reflect community-specific realities and follow a more preventive approach.

Policies that intend to organize the healthcare system tend to drive inequities within the system

Care providers are often reluctant to accept Medicaid insurance because of administrative complexities and reimbursement rates which are a direct result of the federal and state policies. This directly affects individuals who are towards the lower end of socio-economic spectrum because they are dependent on federal/state insurances. This further fuels the healthcare accessibility and inequity and therefore there is a need to more closely address the needs of such communities and address those with a preventive approach.

How we got the solution?

We used mixed method approach to understand the complexity of the healthcare space and its stakeholders. We started with secondary methods to understand and build context and then transitioned into qualitative methods later in the process to hinge our problem framing on people voices.

Understanding the healthcare system focused on Primary care

To understand the healthcare system specifically in the context of primary care, I started with literature review, where I read close to 150+ papers, systematic reviews and journal articles. It helped me have a clear and deep understanding of drivers and barriers in the healthcare system and their interdependencies. However it is important to acknowledge that healthcare space is colossal and I couldn’t go both deep and wide in all the directions hence identified deep dive topics were used as constraints for research areas.

I started with brainstorming on whiteboard with the faculty guide to capture history of healthcare in the united states and key areas of inspection within the boundaries of primary care.

Drivers of primary care were captured and documented. We paid extra attention to base our claims on the facts from literature review.

Insight Boards

A-day-in-life interviews with care providers

We conducted a-day-in life interviews with 4 care providers to understand their perspective about the healthcare system, the challenges they face in their work and understand the expectations of patients from their perspective.

Once we identified the needs, frustrations, pain points and aspirations of the care providers we aligned it with data from the literature review and created a cluster map showing how every stakeholder was struggling with their own issues and some of the issues were conflicting.

Over time we were able to gather a large amount of data on the healthcare system specially in context of primary care.We used communications planning approach to identify the most compelling information that were driving the space, there relationships within the system, leading to key insightsaWe identified that there were several conflicting and mismatched expectation between care providers and patients and we created a map showing why and where that misalignment was happening.

Key Opportunities

Shift towards place based care:

Needs of communities are very specific of the reality around them and not only dependent on the physical health of the patient. There is a need to build care delivery models based on social determinants of health that caters to reflective needs of communities within their community.

Tackling the EHR related burnout for doctors:

Electronic Health Record (EHR) is a major cause of dissatisfaction among both care providers and receivers. There is a need to make the patient document more effective and less burdensome on care providers.

Reforming RVU based payment systems:

Disparities driving healthcare due to payment policies lead to further inefficiencies such as shortage of primary care practitioners, disparity in compensations of primary care practitioners which eventually affects the quality of care delivery to care receiving communities. There is a need to look at policies and modify them to mitigate systemic inequities.

Addressing shortage of primary care practitioners:

Due to reinforcing loops driving the shortage of primary care practitioners the primary care is looking at an acute shortage of practicing doctors. Research suggests that Advance practice nurses and Community health workers can play important roles to fill the gap and reduce burden on primary care doctors. There is a need to reduce the conflict between parties by acknowledging their strengths and weaknesses.

Co-design workshop with community residents

We conducted 3 successive workshops with community residents at Oakley Square in Chicago Westside throughout the process to build a clear understanding about their needs, frustrations and goals from the system.

Workshop 1: Understanding Needs

Focused on understanding and building trust with the community partners, we used (Before, During, After) experience modelling method to learn about their current clinic experience for both Sue Gin clinic and clinics that they visit outside. Once we had the data, we asked the participants to vote for the data considering what they considered most and least important as pain points and needs.

Key Learnings

1. Prevalent Chronic conditions:

All the participants complained about at least one chronic condition

2. Lack of private spaces during the consultation at Sue-Gin Clinic:

Participants who visited both Sue Gin Clinic and clinics outside complained of lack of privacy at the Sue gin clinic which compromised the anonymity of their specific medical conditions within the community.

3. Inconveniences due to bureaucracy:

A majority of the participants complained about difficulty in dealing with bureaucracy related to prescription medicines and insurance which made it difficult for them to navigate through the process.

Workshop 2: Validate and prioritize needs/ generate ideas

Re-assessed the captured needs spaces, understood priorities and ideated for potential solutions to address the problems. These ideas were used to build service prototypes. We provided ideation sheets to the participants and prompted to think about how they would solve their problems. Several problem spaces emerged as area of concern and the top three were – Privacy and anonymity during clinic visits, Mental healthcare and Clarity of information and services provided at specific clinic.

We used a prioritization matrix to access the identified problem spaces and mental health space came out on the top of prioritization.

Workshop 3: Test and refine prototype

We brought 3 service prototypes for 3 need spaces based on idea generation from the workshop 2. These prototypes were a mixture of tangible objects and visual prompts. We gave them those prototypes to use and observed them.

Key Learnings

Prototype 1 : Service Clarity

The users were given QR codes to scan which would take them directly to a webpage with list of services currently being offered at the clinic.

Response:

Senior users boasted of being good with technology but they struggled with using the QR code to see the service list where as younger users were comfortable using the technology and were able to navigate through the steps.

Prototype 2 : Mental health therapy / Highest priority intervention

The users were provided a service model of virtual consultation with a therapist on the other side of the phone/
screen to discuss their metal health issues.

Response:
Virtual mental health therapy session was a big “No” “No” . The participants expected proximity, face-to-face
conversation with their local community residents. They expressed the need to be able to see the person they
were talking to.

Prototype 3 : Privacy

The users were given a QR code. After scanning they navigated to an editable sheet online, where they could
write their health concerns, directly visible to care provides only.

Response:
The idea of using a QR code to draft their healthcare needs instead of speaking them to the clinic staffs in front
of other visitors was a well accepted idea. However the older participants struggled with steps related to using
QR code. Which clearly indicated that it wasn’t a viable solution for them. A high majority of participants
insisted towards a phone call/messaging option which they found more convenient and effective.

Reframing mental health care

A Solution

A mental healthcare service model that focuses on place based care by making the community residents as partners in care delivery.

Consisting of activities that brings community partners together and addresses the community-specific needs of dealing with mental health that often lead to more serious health outcomes such as hypertension and related comorbidities.

Why: Community Cares

Who: The Actors

When and Where: Venue and Timing

Check availability of solution with clients

We presented the final concept prototype of the service model and an implementation plan to the management of Rush University Medical Centre, Sue Gin Clinic and The Community Builders (TCB) team. Post presentation we ran a quick viability check session will all the members and weighed in our idea based on viability, resources, convenience factors using voting. This resulted in further refinement of the model where a few existing details remained as it is, a few were negatively voted and removed and few new ones were added.

Communication Tools

Apart from experience model we also created communications artifacts which would allow the residents to get information related to the CommunityCares sessions. These communications artifact would provide information regarding the venue, timing and topic of the planned session. We specifically choose table standee and fyler format to keep the price o the artifacts low as well safe from vandalism

Takeaways from the project

Detailed planning is key to effective co-design workshop

TWhen addressing complex issue like healthcare in a participatory research setting it is important to have very detailed plan of every activity to get quality data from participants otherwise the sessions can easily be unfruitful because participants have different agendas.

Prioritization of every data extracted is vital

It is also important to affirm priorities and re-affirm it with the participating users when designing healthcare services because healthcare needs are broad and everything seems like an important issue to address and participants want everything but practically everything cannot be solved at once.