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Inspired by people‚ designed for impact.
Moving beyond lucky – design thinking and systems thinking
2
portrait of grandma soboll
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We’re taming the increasing complexity of today’s world with the timeless simplicity of good
design.
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Design Thinking
Design-driven Innovation
Experience Design
Digital Design
Industrial Design
Service Design
What is it that you actually do?
5
Design Thinking
Design-driven Innovation
Experience Design
Digital Design
Industrial Design
Service Design
Systems Thinking
What is it that you actually do?
6
Design Thinking
Design-driven Innovation
Experience Design
Digital Design
Industrial Design
Service Design
Systems Thinking
What is it that you actually do?
7
2 Projects
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Brief: “How might we fight child obesity by getting kids to move more?”
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UNICEF Kid Power Giving kids the power to save lives
Daylight Confidential
UNICEF Kid Power Giving kids the power to save lives
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Challenges are becoming ever more complex and intractable
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Brief: “How might we make Obamacare viable?”
13
The Problem
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Users are a crucial piece of the puzzle – one of many.
Member visits the ED for an emergent/non emergent need.
ED/HOSPITAL REFERRAL
Ongoing- All year around Up to 3 months 12-24 months
ED/Hospital flags the member as an appropriate candidate for Centric.
Coordinates with ED/Hospital and collects data on the member.
History of referrals to Centric; notes and history relevant to assessment of membership.
Member’s medical utilization increases or shows patterns of high utilization.
UTILIZATION PATTERNS
Change of patterns identifies member as candidate for Centric.
Tracks member’s medical utilization; develops and assesses criteria for most strategic high utilizer to invite to Centric.
Member shows signs of being at risk and is impactable.
PROVIDER REFERRAL
Medical, behavioral, or social provider identifies potential high utilizer.
Creates and maintains a system IRU�SURYLGHUV�WR�µDJ�SURVSHFWLYH�Centric members.
Number of ED visits, inmember stays and claims dollars compared to averages.
CONNECT COLLABORATEIDENTIFY GRADUATE
Member travels, or is driven, to Centric and meets with providers on the care team. Member expresses personal needs/wants and works with the care WHDP�WR�GH´QH�FROOHFWLYH�JRDOV�IRU�WKH�Centric experience.
CENTRIC WELCOME
The Advocate accompanies the member on the drive to Centric (or they meet at the entrance) and takes member to their first meeting with the PCP/behaviorist or any other Centric provider based on the need. In mutual agreement, they create an integrated care plan, schedule of home and Centric visits, and ways to measure progress both for member and provider (including app and monitoring tools).
Admin assigns/assembles individual providers of care team to member and schedules in-person meeting of care team.
Centric resources & Centric Dashboard
Informed by member’s history, Centric team records assessment and identifies specific metrics for measuring progress.
History of referrals to Centric; notes and information relevant to assessment of membership.
Member interacts with various social services like food bank and housing shelters.
SOCIAL SERVICES REFERRAL
Social service flag members based on their frequency of utilization and Centric qualifying criteria.
Collaborates with social services to target members at crucial points of contact.
History of members’ social services utilization and perceived needs.
Member calls 911 for non urgent needs frequently.
EMS EARLY WARNING SYSTEM
EMS assesses cases that are non emergent, de-escalates issues and notifies Centric of potential members.
Collaborates with EMS to gather information about the member and asssess impactability.
History of members’ EMS utilization and perceived needs.
Member visits Centric outside of appointments for enriching, empowering, and community-building events.
CENTRIC RESOURCES & EVENTS
Providers create and participate in events in their areas of expertise and passion.
Determines and organizes educational events, gatherings, and resources.
With support from the Advocate, member makes an appointment in advance and arrives, potentially with the help of Centric transport, to the appointment.
IN-CLINIC APPOINTMENT
Centric providers provide health check ups and attend to health needs.
%DFN�RI´FH�LQWHJUDWHV�DOO�VFKHGXOLQJ�DW�Centric.
Member utilizes Centric app to check in with Advocate and monitor progress on health goals. Member receives rewards to achieving health goals.
MONITORING AND CARE MANAGEMENT
Care team, and especially Advocate, checks in with member and monitors health. Provides support, motivation, celebrates milestones and encourages independence along the way.
Keeps the appointment calendar XSGDWHG�DQG�QRWL´HV�WKH�$GYRFDWH�
Centric Dashboard & App
Measurement of progress on specific health conditions and goals (e.g. remote monitoring of blood sugar through a member’s use of glucometer).
Members are able to make same-day appointments.
SAME DAY APPOINTMENT
Open-access scheduling preserves a window of providers’ time for same-day appointments.
Regulates open-access scheduling in response to member’s needs.
Member needs specialty care that spans the medical, behavioral and social realms.
SPECIALTY INPATIENT & OUTPATIENTCARE
The care team revises care plan and reaches out to specialty partners. Advocate helps schedule appointments and supports the member through the care process outside of Centric.
EMR is shared between Centric, specialist, and hospital.
Member experiences sudden or ongoing need for social services such as housing, food, utilities etc.
CONNECT TO SOCIAL SERVICES
Advocate assesses needs for social services. Harnesses Centric’s financial planner/home & community planner, housing services and others to address and follow up on social needs.
:RUNV�ZLWK�$GYRFDWH�IRU�´OLQJ�SDSHU�work for state services.
Centric DashboardCentric Dashboard
CENTRIC SERVICE EXPERIENCE MAPCentric keeps the member at the center of care, supporting the whole patient for long-term health.
- Creates an interdisciplinary team around each patient to address social, behavioral, and medical issues; support the whole patient and promote long-term health.
- Assigns each member a Personal Advocate to integrate care services provided by the interdisciplinary team, help members keep appointments, support healthy behavior, and address issues before they become critical.
- Meets members where they are, using a combination of home visits, advanced technology, and a central headquarters for basic care.
- Provides residence-based support that offers a lifeboat out of the hospital and into a more sustainable way of living.
This document describes some of the discrete moments that make up the Centric experience. While some of these are sequential and are denoted by arrows, not all members will experience each moment. Look below for details on how to read each box.
Member travels, or is driven, to the Centric, and meets with providers on the care team. Member works with the FDUH�WHDP�WR�GH´QH�WKHLU�JRDOV�IRU�WKH�Centric experience.
CENTRIC WELCOME
The Advocate drives the member to Centric, or they meet at the entrance, and takes the member to his/her 45 minute appointment. In the appointment they are joined by the PCP, RN, behavioral health ARNP, and any other Centric staff requested in the initial assessment. They agree on a integrated care plan, schedule of home and clinic visits, and assessment strategy.
Admin assigns/assembles individual providers of care team to member. Schedules in-person meeting of care team.
Care team roster & Centric OS
Informed by member’s history, Centric team records assessment and makes available to the care team.
TOOL
TESTABLE MOMENT
MEMBER ACTION
PROVIDER ACTION
BACK OFFICE ACTION
DATA CAPTURED AND METRICS OF SUCCESS
MEMBER ABILITY TO TAKE DECISION
COLORS DENOTE WHICH PART OF THE
CENTRIC IS ACTIVE
IDENTIFY AS CENTRIC CANDIDATE
Staff medical director and care team have a weekly meeting to evaluate whether identified Centric candidates are to be invited to become members.
Centric CriteriaCentric Criteria
Preliminary assessment of candidate as vulnerable and impactable.
Assess against criteria for most strategic members to invite to Centric.
Member is available and present for the appointment.
AT HOME APPOINTMENTS
Advocate, NP, PCP and other care team members meet member at home, equipped with portable medical equipment. Appointments of less complexity are facilitated by the Advocate through telehealth.
Manage the back end systems for making in-home and virtual tele-health appointments possible.
Centric Dashboard & Telehealth
Member may be present and expresses personal needs and wants.
CARE CONFERENCE
Care team providers meet bi-weekly to discuss progress from a medical, behavioral, and social lens.
Aggregate and provide data on health progress.
Centric Integrated EMR
Because of the tendency for high utilizers to relapse, we expect most Centric members will always be Centric members. But as the number of touches drops over time members may "graduate" by being invited to give back to the Centric community, thus becoming members and participants.
GRADUATION
Advocate continues regular - but less frequent - check-ins and makes sure the member feels connected to Centric.
Continues to manage strategic communication of member's health and social determinants progress while also creating opportunities for member involvement in Centric, such as assisting new members, offering peer counseling, etc.
Detailed and at-a-glance take on member’s progress at Centric.
Member calls the 24x7 Centric number anytime between 8pm and 7am.
24/7 CENTRIC
Centric provides 24/7 nurse phone/video-line to triage various needs. The nurse attempts to de-escalate issue, connects to care team and schedules appointments for the next morning if necessary. Community EMT’s fill in for the Advocates during after hours.
Centric App
Capture and prepare pareto analysis of needs and answers. Channels Centric members’ calls from EMT and ED during afterhours.
CENTRIC
MED
ICAL BEHAV
IOR
AL
SOCIAL
Member gets to know the Advocate and Centric better.
Advocate reaches out to the member and tries to build a trusting relationship by understanding their unique situation and needs and offering some help.
TRUST BUILDING
INVITATION TO ENGAGE
Member receives an invitation to join Centric. Member accepts or refuses.
Advocate descibes the value of Centric for the member and invites them to be a part of Centric. Advocate also requests signature for release from the member.
Upon acceptance of the invitation, member account is created in Centric EMR and health history is aggregated.
Member agrees to a visit from the Advocate and Registered Nurse.
HOME CONNECTION
Advocate and Registered Nurse visit member’s home. They listen, understand and assess members social, behavioral, and medical needs; they then schedule an appointment with specific providers at Centric. Advocate also schedules transportation and introduces the Centric app for easy connectivity.
Routes medical history to Centric and makes available to Advocate and Registered Nurse. After home visit, Advocate’s and Registered Nurse’s assessments are added to member page.
Informed by member’s history, Advocate interactions, Centric team records assessment and makes available to the rest of the care team .
Centric tools
15
But we need to know more to move beyond lucky
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Three key benefits of systems thinking
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1. Gain holistic view, understand patterns (system)
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INSUFFICIENT
HOUSING FOR LOW
INCOME
LACK OF SOCIAL
CAPITAL/STANDING
AMONG POOR
BAD HABITS
COMPOUNDING
FINANCIAL PROBLEMS
NOT ENOUGH JOB
OPPORTUNITIES
LOW COST FOOD
LEADS TO POOR
NUTRITION
RELUCTANCE ( ESP.OF
IMMIGRANTS) TO
ENGAGE WITH
GOVERNMENT
AGENCIES
NOT ENOUGH TRADE
EDUCATION
OPPORTUNITIES THAT
ALIGN WITH LOCAL
ECONOMY
POVERTY PREVENTS
LONG-TERM FOCUS IN
PRIORITIES
HIGH RATES OF
BEHAVIORAL ISSUES,
INCL. DRUG ABUSE
HOMELESSNESS
CREATES SOCIAL
STIGMA
MISTRUST OF
GOVERNMENT
REPRESENTATIVES
DON’T FEEL LIKE
VALUED PART OF
SOCIETY
CHRONIC DISEASES
SPREAD AND GO
UNTREATED FOR TOO
LONG
LACK OF ADDRESS
PREVENTS USERS
FROM ENGAGING WITH
VITAL SERVICES
BAD CREDIT HISTORY
PREVENTS USERS FROM RENTING A
HOME
UNSTABLE FAMILY
DYNAMICS LEAD TO
PSYCHOLOGICAL
PROBLEMS
1. Gain holistic view, understand patterns (interconnectedness)
19
No housing
No address
Debt
Frequent acute health issues,
visits to the emergency room
Underemployed
No relationship with
primary care physician
No steady job due to
unstable health Don’t get reminders about
preventative health measures
Causality Loops e.g. around determinants of healthCausality Loops
Missed medical appointments
No credit
20
No housing
No address
Debt
Frequent acute health issues,
visits to the emergency room
Underemployed
No relationship with
primary care physician
No steady job due to
unstable health Don’t get reminders about
preventative health measures
Causality Loops
Missed medical appointments
No credit
21
No housing
No address
Debt
Frequent acute health issues,
visits to the emergency room
Underemployed
No relationship with
primary care physician
No steady job due to
unstable health Don’t get reminders about
preventative health measures
Causality Loops
Missed medical appointments
No credit
2. Find points of leverage
22
No housing
No address
Debt
Frequent acute health issues,
visits to the emergency room
Underemployed
No relationship with
primary care physician
No steady job due to
unstable health Don’t get reminders about
preventative health measures
Missed medical appointments
Causality Loops
3. Track impact step-by-step
No credit
2. Find points of leverage
23
1. Understand patterns 2. Find points of leverage 3. Track impact step-by-step
24
Is systems thinking the new design thinking?
24
25
Dealing with complex challenges
Trusting in process
Iterative
COMMONALITIES
Systems Thinking and Design Thinking
26
geared towards action
optimistic, generative
user perspective
bottom up
tangible, nuanced, granular
analytical
neutral, modelling
expert perspective
top down
abstract, theoretical
Design Thinking Systems Thinking
Systems Thinking and Design Thinking
DIFFERENCES
27
Combining both
Define opportunity
Create Solutions
Track Impact
Iterate
Design
Thinking
Systems
Thinking
28
29
Member visits the ED for an emergent/non emergent need.
ED/HOSPITAL REFERRAL
Ongoing- All year around Up to 3 months 12-24 months
ED/Hospital flags the member as an appropriate candidate for Centric.
Coordinates with ED/Hospital and collects data on the member.
History of referrals to Centric; notes and history relevant to assessment of membership.
Member’s medical utilization increases or shows patterns of high utilization.
UTILIZATION PATTERNS
Change of patterns identifies member as candidate for Centric.
Tracks member’s medical utilization; develops and assesses criteria for most strategic high utilizer to invite to Centric.
Member shows signs of being at risk and is impactable.
PROVIDER REFERRAL
Medical, behavioral, or social provider identifies potential high utilizer.
Creates and maintains a system IRU�SURYLGHUV�WR�µDJ�SURVSHFWLYH�Centric members.
Number of ED visits, inmember stays and claims dollars compared to averages.
CONNECT COLLABORATEIDENTIFY GRADUATE
Member travels, or is driven, to Centric and meets with providers on the care team. Member expresses personal needs/wants and works with the care WHDP�WR�GH´QH�FROOHFWLYH�JRDOV�IRU�WKH�Centric experience.
CENTRIC WELCOME
The Advocate accompanies the member on the drive to Centric (or they meet at the entrance) and takes member to their first meeting with the PCP/behaviorist or any other Centric provider based on the need. In mutual agreement, they create an integrated care plan, schedule of home and Centric visits, and ways to measure progress both for member and provider (including app and monitoring tools).
Admin assigns/assembles individual providers of care team to member and schedules in-person meeting of care team.
Centric resources & Centric Dashboard
Informed by member’s history, Centric team records assessment and identifies specific metrics for measuring progress.
History of referrals to Centric; notes and information relevant to assessment of membership.
Member interacts with various social services like food bank and housing shelters.
SOCIAL SERVICES REFERRAL
Social service flag members based on their frequency of utilization and Centric qualifying criteria.
Collaborates with social services to target members at crucial points of contact.
History of members’ social services utilization and perceived needs.
Member calls 911 for non urgent needs frequently.
EMS EARLY WARNING SYSTEM
EMS assesses cases that are non emergent, de-escalates issues and notifies Centric of potential members.
Collaborates with EMS to gather information about the member and asssess impactability.
History of members’ EMS utilization and perceived needs.
Member visits Centric outside of appointments for enriching, empowering, and community-building events.
CENTRIC RESOURCES & EVENTS
Providers create and participate in events in their areas of expertise and passion.
Determines and organizes educational events, gatherings, and resources.
With support from the Advocate, member makes an appointment in advance and arrives, potentially with the help of Centric transport, to the appointment.
IN-CLINIC APPOINTMENT
Centric providers provide health check ups and attend to health needs.
%DFN�RI´FH�LQWHJUDWHV�DOO�VFKHGXOLQJ�DW�Centric.
Member utilizes Centric app to check in with Advocate and monitor progress on health goals. Member receives rewards to achieving health goals.
MONITORING AND CARE MANAGEMENT
Care team, and especially Advocate, checks in with member and monitors health. Provides support, motivation, celebrates milestones and encourages independence along the way.
Keeps the appointment calendar XSGDWHG�DQG�QRWL´HV�WKH�$GYRFDWH�
Centric Dashboard & App
Measurement of progress on specific health conditions and goals (e.g. remote monitoring of blood sugar through a member’s use of glucometer).
Members are able to make same-day appointments.
SAME DAY APPOINTMENT
Open-access scheduling preserves a window of providers’ time for same-day appointments.
Regulates open-access scheduling in response to member’s needs.
Member needs specialty care that spans the medical, behavioral and social realms.
SPECIALTY INPATIENT & OUTPATIENTCARE
The care team revises care plan and reaches out to specialty partners. Advocate helps schedule appointments and supports the member through the care process outside of Centric.
EMR is shared between Centric, specialist, and hospital.
Member experiences sudden or ongoing need for social services such as housing, food, utilities etc.
CONNECT TO SOCIAL SERVICES
Advocate assesses needs for social services. Harnesses Centric’s financial planner/home & community planner, housing services and others to address and follow up on social needs.
:RUNV�ZLWK�$GYRFDWH�IRU�´OLQJ�SDSHU�work for state services.
Centric DashboardCentric Dashboard
CENTRIC SERVICE EXPERIENCE MAPCentric keeps the member at the center of care, supporting the whole patient for long-term health.
- Creates an interdisciplinary team around each patient to address social, behavioral, and medical issues; support the whole patient and promote long-term health.
- Assigns each member a Personal Advocate to integrate care services provided by the interdisciplinary team, help members keep appointments, support healthy behavior, and address issues before they become critical.
- Meets members where they are, using a combination of home visits, advanced technology, and a central headquarters for basic care.
- Provides residence-based support that offers a lifeboat out of the hospital and into a more sustainable way of living.
This document describes some of the discrete moments that make up the Centric experience. While some of these are sequential and are denoted by arrows, not all members will experience each moment. Look below for details on how to read each box.
Member travels, or is driven, to the Centric, and meets with providers on the care team. Member works with the FDUH�WHDP�WR�GH´QH�WKHLU�JRDOV�IRU�WKH�Centric experience.
CENTRIC WELCOME
The Advocate drives the member to Centric, or they meet at the entrance, and takes the member to his/her 45 minute appointment. In the appointment they are joined by the PCP, RN, behavioral health ARNP, and any other Centric staff requested in the initial assessment. They agree on a integrated care plan, schedule of home and clinic visits, and assessment strategy.
Admin assigns/assembles individual providers of care team to member. Schedules in-person meeting of care team.
Care team roster & Centric OS
Informed by member’s history, Centric team records assessment and makes available to the care team.
TOOL
TESTABLE MOMENT
MEMBER ACTION
PROVIDER ACTION
BACK OFFICE ACTION
DATA CAPTURED AND METRICS OF SUCCESS
MEMBER ABILITY TO TAKE DECISION
COLORS DENOTE WHICH PART OF THE
CENTRIC IS ACTIVE
IDENTIFY AS CENTRIC CANDIDATE
Staff medical director and care team have a weekly meeting to evaluate whether identified Centric candidates are to be invited to become members.
Centric CriteriaCentric Criteria
Preliminary assessment of candidate as vulnerable and impactable.
Assess against criteria for most strategic members to invite to Centric.
Member is available and present for the appointment.
AT HOME APPOINTMENTS
Advocate, NP, PCP and other care team members meet member at home, equipped with portable medical equipment. Appointments of less complexity are facilitated by the Advocate through telehealth.
Manage the back end systems for making in-home and virtual tele-health appointments possible.
Centric Dashboard & Telehealth
Member may be present and expresses personal needs and wants.
CARE CONFERENCE
Care team providers meet bi-weekly to discuss progress from a medical, behavioral, and social lens.
Aggregate and provide data on health progress.
Centric Integrated EMR
Because of the tendency for high utilizers to relapse, we expect most Centric members will always be Centric members. But as the number of touches drops over time members may "graduate" by being invited to give back to the Centric community, thus becoming members and participants.
GRADUATION
Advocate continues regular - but less frequent - check-ins and makes sure the member feels connected to Centric.
Continues to manage strategic communication of member's health and social determinants progress while also creating opportunities for member involvement in Centric, such as assisting new members, offering peer counseling, etc.
Detailed and at-a-glance take on member’s progress at Centric.
Member calls the 24x7 Centric number anytime between 8pm and 7am.
24/7 CENTRIC
Centric provides 24/7 nurse phone/video-line to triage various needs. The nurse attempts to de-escalate issue, connects to care team and schedules appointments for the next morning if necessary. Community EMT’s fill in for the Advocates during after hours.
Centric App
Capture and prepare pareto analysis of needs and answers. Channels Centric members’ calls from EMT and ED during afterhours.
CENTRIC
MED
ICAL BEHAV
IOR
AL
SOCIAL
Member gets to know the Advocate and Centric better.
Advocate reaches out to the member and tries to build a trusting relationship by understanding their unique situation and needs and offering some help.
TRUST BUILDING
INVITATION TO ENGAGE
Member receives an invitation to join Centric. Member accepts or refuses.
Advocate descibes the value of Centric for the member and invites them to be a part of Centric. Advocate also requests signature for release from the member.
Upon acceptance of the invitation, member account is created in Centric EMR and health history is aggregated.
Member agrees to a visit from the Advocate and Registered Nurse.
HOME CONNECTION
Advocate and Registered Nurse visit member’s home. They listen, understand and assess members social, behavioral, and medical needs; they then schedule an appointment with specific providers at Centric. Advocate also schedules transportation and introduces the Centric app for easy connectivity.
Routes medical history to Centric and makes available to Advocate and Registered Nurse. After home visit, Advocate’s and Registered Nurse’s assessments are added to member page.
Informed by member’s history, Advocate interactions, Centric team records assessment and makes available to the rest of the care team .
Centric tools
30
Pilot launching next week.
31
Inspired by people‚ designed for impact.
SYSTEMSPRAC TI C E
Handbook of Systems Thinking (Social Innovation)
www.daylightdesign.com/news
