Why do people hire primary care?
“Jobs to be Done” can start out feeling oversimplified. They pack a punch when paired with direct quotes and are categorized.
Context:
Sutter Health is one of the nation's largest nonprofit healthcare systems, serving over 3 million patients in Northern California. Sutter's leadership approached our internal Design & Innovation team in early 2017 with a big ask. It felt like someone said, "we know primary care isn't working. We know we need to deliver a financially viable human-centered experience. Go."
This project was my focus for nearly three years. As one of three full-time experience designers on Sutter Health's Design & Innovation team, I wore every design hat imaginable. We launched a new primary care offering within 12 months of the project's inception.
My contributions:
concept sketching
content writing
synthesis
presenting to and collaborating with leadership
illustration
conducting feedback sessions
If you haven’t yet read about the research phase of this project, learn more about its origin story here.
Ideation
This phase of the project was all about thinking broadly. With baseline research and persona-development behind us, we were ready to generate as many concepts for our users as possible. Here's how our mini-sprints worked:
Ask: design for "everyday health" to replace traditional primary care
Location: anywhere (not limited to clinical spaces)
Themes: rethink the space; digital-first; decentralize care; rethink the 1:1 ratio
Timeframe: 2 weeks/theme
Personas: each designer was assigned a persona
I led a multidisciplinary group including physicians, ops-specialists, and administrators and coached them along the HCD process. While we designers did the bulk of concept development, we brought ideas and sketches to the SME group for iteration and review on a weekly basis. During those sessions, I’d often bring us back to the persona we were designing for (Victor) by posing questions or parts of his narrative to the group. Cumulatively, we generated over 50 concepts. Not all of them proved to be viable or feasible for our health system, but because they were based directly on what we heard from people, they were desirable.
Feedback
We got feedback early and often. Meeting with our multidisciplinary groups meant rigorous concept vetting (read: culling) and internal subject matter expertise. I led sessions that were focused on my persona, and worked with my project manager to determine each concept's next steps---even if that meant sending it out to pasture.
As for gathering external feedback, we used a few methods. Earlier on in this phase, we created a museum-like exhibit in one of our hospitals. We left Post-Its and markers out for patients and staff to respond to what they were seeing. A colleague illustrated the majority of what you see below, and I was a main copywriter. We included poignant quotes on these posters to help people connect with what they were seeing.
Further along in the iteration process we recruited a range of participants and conducted sessions in-person, and via Zoom. Our goal was to speak with people across various spectrums of health, not limiting ourselves to those similar to our personas. By this phase of the work, designers had paired up to share the workload, and to ensure smooth testing sessions. We gathered feedback using a combination of paper-prototyping and illustrating narratives around each concept for testing. I illustrated all narratives and icons (below), created a testing plan, and conducted feedback sessions.
Here's some of what we heard:
Welcome me to this new health offering, and show me value right away.
Maintain my health in the easiest way possible.
Protect me from going down a wormhole, and self-diagnosing.
Fix me when I have an acute health need or issue.
Growth is important too. Help me be my best self.
We found that testing with these narratives was highly effective. Rather than testing a concept at face value, the narrative provided necessary context. People could easily envision how the concept would be used, or what "mode" they might be in regarding their health.
Launch
By this time, TeraPractice had been gaining momentum alongside our concept work. It started off slow, with just a handful of patients continually providing feedback about the model. During that time, design teammates and I were consulted regularly to ensure the practice's offerings were in alignment with our foundational research, and the subsequent ideation.
Our team of three designers "embedded" within TeraPractice and maintained a close relationship with Dr. Taylor, the practice's lead physician. Over the next year, we built the TeraPractice brand, website, intake survey, onboarding materials... The list goes on. In designing many of these materials, I found Erika Hall's work on Conversational Design highly influential.
Listening vs hearing
Sometimes my job means making tone of a conversation feels safe, friendly and informative. This comes naturally if you have a solid connection with your end user, and frequently solicit feedback.
I also took the lead on any behavior-change aspects of the practice. This meant recruiting and hiring TeraPractice's first health coach, and developing an ideology around sustainable goal-setting practices for all sorts of patients.
Designing for behavior change
By working with TeraPractice, I developed a toolkit to support healthy, sustainable behavior change in clinical settings. These materials are now available to coaches across Sutter Health.
TeraPractice is alive and well.
As I transitioned out of Sutter, there were nearly 1000 patients actively using TeraPractice as their primary form of care. As you can glean from the website we developed, the practice is a unique, convenient and personal model that uses technology as best it can... Within the confines of being on EPIC's electronic medical record (EMR); I've designed in more-nimble EMRs, so EPIC had me pulling my hair out at times.
Another crucial tactic in our process was aligning directly with Sutter Health's (capitated) insurance plan. Once the incentives were aligned for TeraPractice, designing the "right" experience for patients and clinicians was a lot easier.
This is a service design relic I made to communicate some of the interactions someone could have with Tera's health coach. "H3" refers to Horizon 3. Because we were designing for years in the future, we found the Three Horizons framework very helpful.
There is so much I am not including in this story. If you'd like to discuss any of the work, or learn more about my superpowers, drop me a line.