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A Reflection on
Canada’s 2015
Syrian Refugee
Operation
IN FLUX
TODAY’S FOCUS
1	 Background
2 	 Our Role
3 	 Adapting
4 	 The Sprint
5 	 The Arrival
6 	 Reflection
TODAY’S FOCUS
Canada’s Syrian Refugee Operation
Case study through a service design lens:
BACKGROUND
Bernard Weil | Getty Images
Bernard Weil | Getty Images
35,147
Relocated to Date
SYRIAN REFUGEES
Context in a nutshell
Peter Macdiarmid | Getty Images
Arab Spring Uprisings
Syrian Civil War
Matteo Rovella Pictures
Mass Displacement
of 4,810,216 People
Khalil Mazraawi | Getty Images
Varied International
Responses
DIFFERENT PERSPECTIVES
From Western Audiences
If Europe fails on the question of
refugees, then it won’t be the
Europe we wished for.
- Angela Merkel
I’m putting the people on notice that are coming
here from Syria as part of this mass migration,
that if I win, if I win, they’re going back.
- Donald Trump
Canadian Press
Key tenet of Trudeau’s
election platform
This is not just about welcoming 25,000
Syrian refugees...
- Justin Trudeau
...It’s welcoming 25,000 new Canadians.
- Justin Trudeau
OUR ROLE
Goverment operation
involving many groups
Federal, provincial, municipal,
military, NGOs & volunteers
Medical ‘SWAT Team’
Mass casualty events, medical
crises, unique emergencies
Can deploy anywhere in the
province, on short notice
Taxi Driver (1976) | Columbia Pictures
Talkin’ to me?
“You’re the human factors guy”
Taxi Driver (1976) | Columbia Pictures
ADAPTING
Show up at 6:00am at this address
and we’ll go from there.
Just soak it all in
Ethnography, co-design,
experience mapping,
prototyping, etc.
Keep the toolbox in mind
Project Description
As part of the Healthcare Human Factors website refresh,
a video will be made to showcase our service offerings
Project Considerations
— motion graphics overlay (if applicable)
Project Brief
HEALTHCARE HUMAN FACTORS PROMO VIDEO
Desired “deliverable”
was undefined
So ask yourself:
What is the ideal output?
THE SPRINT
An ever-evolving situation
—	 When are they coming?
—	 How and where will they arrive?
—	 Who exactly are they?
—	 Where will they stay? For how long?
—	 What is their physical condition?
—	 What is their mental state?
—	 How many will speak English?
—	 When will we get answers?
EMAT
1 Provide primary care clinic support
	A at arrival point (Pearson)
	B at interim lodging sites (ILSs)
Healthcare Human Factors
1 Connect all the dots
2 Package up for EMAT
Whole bunch of organizations
1 Identify & vet refugees
2 Figure out details of their arrival
3 Figure out where they’ll stay
4 Plan for their long-term success
EMAT
1 Provide primary care clinic support
	A at arrival point (Pearson)
	B at interim lodging sites (ILSs)
Healthcare Human Factors
1 Connect all the dots
2 Package up for EMAT
Whole bunch of organizations
1 Identify & vet refugees
2 Figure out details of their arrival
3 Figure out where they’ll stay
4 Plan for their long-term success
EMAT
1 Provide primary care clinic support
	A at arrival point (Pearson)
	B at interim lodging sites (ILSs)
Healthcare Human Factors
1 Connect all the dots
2 Package up for EMAT
Whole bunch of organizations
1 Identify & vet refugees
2 Figure out details of their arrival
3 Figure out where they’ll stay
4 Plan for their long-term success
6:00 am
Show up at this address...
Shadowing
Planning
Mapping
Collaborating &
Synthesizing
Dry-running
Deliverable?
“Guidebook document”
DECEMBER 2015
ONTARIO EMAT
PRIMARY CARE CLINICS
FOR SYRIAN REFUGEES:
SETUP GUIDEBOOK
12EMAT: Primary Care Clinic Setup Guide (Dec 2015)
Recommended Reading
Western Australian Health Care
Providers’ Handbook on Muslim Patients
First Edition 2014
This handbook provides a comprehensive
primer to healthcare workers who
may have little experience in providing
care to Muslim patients. It details
Islamic cultural practices such as
prayer times, outlook on gender, dietary
considerations, and more.
Download PDF here
Western Australian
Health Care Providers’ Handbook
on Muslim Patients
First Edition
Entrance	
	
	
	
	
	
																																																																																																																	
																																																																																																																	Reception	area	
	
	
	
	
	
	
Med	
Supplies	
BED	#2	
BED	#1	
PS	area	
	
	
HS/Masks	
Play	area	
ESP	
cart	
PS	files	for	assessment	
General	Filing	
Returning	Visit	Files	
Today	Assessment	Files	
Waiting	area		
Supply	area	
																																		LEGEND	
											-	Desk	with	LB	12														-	Recycling	container	
											-	Sharps	container																			-	Storage	bin								
											-	Bio-hazard	waste	receptacle	
											-	Regular	waste	receptacle	
													-	Security	
	
Secure	storage	bin	for	
meds		
Soiled	Utility	
Room	
Key	Concepts	
For	privacy	and	cultural	issue,	no	two	doors	
of	patient	exam	area	should	face	each	other.	
And	patient	flow	should	not	pass	in	front	of	
another	exam	room.	Exam	room	includes	PS	
area.	
	
Computer	
1
2
3
4
5
Suggested Clinic Layout (Generic)
*This suggested layout is based on a generic warehouse space; customization on a per-site basis is to be expected
sk
ily
as
y)
Require
belongings
bag?
First Visit or
Follow-Up?
Follow-
Up
Put belongings
in bag(s);
carry bag(s)
throughout clinic
Y
N
TION (2) REGISTRATION DESK (3) WA
Proceed to
Registration
Queue
Receive patient
First
Visit
Start New
Charting
Folder
Take 2 ID
Stickers; Place
1 on Chart and
1 on Bracelet
Apply
Bracelet to
Patient
Place Chart in
"To Be Seen"
Queue Bin for
Treatment or
Psychosocial
Direct Patient
to Waiting Area
Dialogue with
PT;
Input
Intake Info into
Excel
Ask for Name
Find Chart
in "Follow-Up"
Bin
(Alphabetical;
Last Name)
Write ID onto
New (Blank)
Bracelet
and Apply to
Patient
Patient
still has ID
Bracelet?
N
Dialogue with
PT;
Update
Intake Info into
Excel
Y
Proceed to
Waiting Area
Take Next Chart
from
"To Be Seen for
Treatment"
Queue Bin
Ready for
New Patient
Call Out PT
Name and/o
(Confer wit
Translator a
Necessary
Wait to be Called
and Escorted
by Medical
Professional
Proceed Back
to Waiting Area
Ready for
New Patient
Take Next Chart
from
"To Be Seen for
Psychosocial"
Queue Bin
Call Out PT's
Name and/or ID
(Confer with
Translator as
Necessary)
Entry into Clinic
Observe
Pre-Registration
Signage
Put on mask
(self + family
members as
necessary)
Lodging
Observing
fever?
Y
PATIENT+FAMILYADMIN/CLERKMEDICALWORKERPSYCHOSOCIALER
Require
belongings
bag?
First Visit or
Follow-Up?
Follow-
Up
N
Put belongings
in bag(s);
carry bag(s)
throughout clinic
Y
N
(1) PRE-REGISTRATION (2) REGISTRATION D
Proceed to
Registration
Queue
Receive patient
First
Visit
Start New
Charting
Folder
Take 2 ID
Stickers; Place
1 on Chart and
1 on Bracelet
Dialogue with
PT;
Input
Intake Info into
Excel
Ask for Name
Find Chart
in "Follow-Up"
Bin
(Alphabetical;
Last Name)
Patient
still has ID
Bracelet?
Treatment Area
StaffInventoryProcess
Station
Step
Purpose For medical staff
conducting assessments:
• Clear separation from
waiting area and other
treatment areas for
privacy reasons
• Easy access to medical
supplies & cleaning
Required:
• 2 x medical professional
(RN, NP, and/or MD)
(Medical staff must have at
least 1 female on shift at a
time for cultural sensitivity)
Required:
• Primary PT assessment
Possible escalations:
• To MD (consult call)
• To EMS
• To Psychosocial health
• To Diagnostics
4
Treatment
Required per station:
• Bed for PT + 2 chairs
• LP12 or AED + table
• Crash bag
• Biohazard container
• Sharps container
• Privacy (room / dividers)
Treatment bed
LP12 or AED
Temporary dividers
as necessary
Chairs and/or table
for supplies
24EMAT: Primary Care Clinic Setup Guide (Dec 2015)
Pearson Infield Terminal Setup
Gate 523:
Flow of refugees
disembarking from plane
into terminal; walk through
glass entryway to Gate 521
CBSA Officers on the lookout for
communicable diseases to escalate to
PHAC RNs if necessary
PHAC RNs
Welcome Centre
CBSATerminals
Gate 521:
Welcome to Canada!
Proceed to CBSA
Waiting Area
Service Canada
EMAT
CBSAWaitingArea
Flow through Pearson (Detailed)
Fit to fly? Y
N
DND HCPs:
1 x MD
1 x RN
Staffed on plane
Event Start
IME Screening
at Origin Point by
DND Personnel
Jordan/Lebanon
1.0
Board plane and
travel to
Toronto, Canada
2.0
Arrival at
Pearson Airport
3.0
Disembark
(Gate 523)
4.0 MD/RN
identified
for med
assistance?
N
Y
Proceed to
receive primary
care assessment
@ EMAT
EMAT
Proceed to
PHAC
Quarantine RNs
PHAC
Quarantine
flag for
EMAT?
N
Y
Proceed
to CBSA
Processing
5.0
Proceed to
Welcome Centre
(Receive clothing)
7.0
Identifies patients in need of assistance
Placement
arranged?
Placement to
pre-arranged
location in
Canada
8.A
Proceed to
Interim Lodging
Site (ILS)
8.B
Y
N
Self-identify
for medical
assistance?
N
Y
Proceed to
Service Canada
(Receive SIN #)
6.0
EMS
Critical?
YN
Exit to EMS
(Peele Medics)
Proceed to Next Station
in Process
(CBSA if not yet processed, or
Service Canada if they have
already gone through CBSA)
CONTINUE ON
EMS
Critical?
YN
70EMAT: Primary Care Clinic Setup Guide (Dec 2015)
Inbound refugees will be gradually acclimatized to Canadian culture, but are
expected to undergo a period of learning and education regarding acceptable
practices and behaviour that may greatly contrast what is normal for them.
Accordingly, all clinic staff are expected to exercise appropriate sensitivity,
tact, and discretion in handling culturally sensitive scenarios that may arise.
SITUATIONS REQUIRING ESCALATION:
Call EMAT EOC: 1-800-680-7260
When in Doubt: Call EMAT
Rolling with the punches
—	 Info changing all the time
—	 Lots of unknowns
—	 Intense / urgent situation
—	 Little time to manicure output
—	 Unique design challenges
(language + cultural + religious customs)
THE ARRIVAL
DECEMBER 2015
First flights @ Pearson
Stacey Newman | Shutterstock.com
Mark Blinch | Reuters
Nathan Denette | The Canadian Press
REFLECTION
Looking back
—	 Service design is a powerful “lens”
—	 Work within your constraints
—	 Be thankful you live in Canada :)
—	 If you want to get involved...
#WelcomeRefugees
Bernard Weil | Getty Images
A Reflection on
Canada’s 2015
Syrian Refugee
Operation
THANK YOU
Questions?

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Welcome Home: Designing the Syrian Refugee Intake Experience - Justin Kirkey

  • 1. A Reflection on Canada’s 2015 Syrian Refugee Operation IN FLUX
  • 2.
  • 4. 1 Background 2 Our Role 3 Adapting 4 The Sprint 5 The Arrival 6 Reflection TODAY’S FOCUS Canada’s Syrian Refugee Operation Case study through a service design lens:
  • 6. Bernard Weil | Getty Images
  • 7. Bernard Weil | Getty Images 35,147 Relocated to Date
  • 9. Peter Macdiarmid | Getty Images Arab Spring Uprisings
  • 11. Matteo Rovella Pictures Mass Displacement of 4,810,216 People
  • 12. Khalil Mazraawi | Getty Images Varied International Responses
  • 14. If Europe fails on the question of refugees, then it won’t be the Europe we wished for. - Angela Merkel
  • 15. I’m putting the people on notice that are coming here from Syria as part of this mass migration, that if I win, if I win, they’re going back. - Donald Trump
  • 16. Canadian Press Key tenet of Trudeau’s election platform
  • 17. This is not just about welcoming 25,000 Syrian refugees... - Justin Trudeau
  • 18. ...It’s welcoming 25,000 new Canadians. - Justin Trudeau
  • 20. Goverment operation involving many groups Federal, provincial, municipal, military, NGOs & volunteers
  • 21.
  • 23. Mass casualty events, medical crises, unique emergencies Can deploy anywhere in the province, on short notice
  • 24. Taxi Driver (1976) | Columbia Pictures Talkin’ to me?
  • 25. “You’re the human factors guy” Taxi Driver (1976) | Columbia Pictures
  • 27. Show up at 6:00am at this address and we’ll go from there.
  • 28. Just soak it all in
  • 30. Project Description As part of the Healthcare Human Factors website refresh, a video will be made to showcase our service offerings Project Considerations — motion graphics overlay (if applicable) Project Brief HEALTHCARE HUMAN FACTORS PROMO VIDEO Desired “deliverable” was undefined
  • 31. So ask yourself: What is the ideal output?
  • 33. An ever-evolving situation — When are they coming? — How and where will they arrive? — Who exactly are they? — Where will they stay? For how long? — What is their physical condition? — What is their mental state? — How many will speak English? — When will we get answers?
  • 34. EMAT 1 Provide primary care clinic support A at arrival point (Pearson) B at interim lodging sites (ILSs) Healthcare Human Factors 1 Connect all the dots 2 Package up for EMAT Whole bunch of organizations 1 Identify & vet refugees 2 Figure out details of their arrival 3 Figure out where they’ll stay 4 Plan for their long-term success
  • 35. EMAT 1 Provide primary care clinic support A at arrival point (Pearson) B at interim lodging sites (ILSs) Healthcare Human Factors 1 Connect all the dots 2 Package up for EMAT Whole bunch of organizations 1 Identify & vet refugees 2 Figure out details of their arrival 3 Figure out where they’ll stay 4 Plan for their long-term success
  • 36. EMAT 1 Provide primary care clinic support A at arrival point (Pearson) B at interim lodging sites (ILSs) Healthcare Human Factors 1 Connect all the dots 2 Package up for EMAT Whole bunch of organizations 1 Identify & vet refugees 2 Figure out details of their arrival 3 Figure out where they’ll stay 4 Plan for their long-term success
  • 37. 6:00 am Show up at this address...
  • 44. DECEMBER 2015 ONTARIO EMAT PRIMARY CARE CLINICS FOR SYRIAN REFUGEES: SETUP GUIDEBOOK
  • 45. 12EMAT: Primary Care Clinic Setup Guide (Dec 2015) Recommended Reading Western Australian Health Care Providers’ Handbook on Muslim Patients First Edition 2014 This handbook provides a comprehensive primer to healthcare workers who may have little experience in providing care to Muslim patients. It details Islamic cultural practices such as prayer times, outlook on gender, dietary considerations, and more. Download PDF here Western Australian Health Care Providers’ Handbook on Muslim Patients First Edition
  • 47. sk ily as y) Require belongings bag? First Visit or Follow-Up? Follow- Up Put belongings in bag(s); carry bag(s) throughout clinic Y N TION (2) REGISTRATION DESK (3) WA Proceed to Registration Queue Receive patient First Visit Start New Charting Folder Take 2 ID Stickers; Place 1 on Chart and 1 on Bracelet Apply Bracelet to Patient Place Chart in "To Be Seen" Queue Bin for Treatment or Psychosocial Direct Patient to Waiting Area Dialogue with PT; Input Intake Info into Excel Ask for Name Find Chart in "Follow-Up" Bin (Alphabetical; Last Name) Write ID onto New (Blank) Bracelet and Apply to Patient Patient still has ID Bracelet? N Dialogue with PT; Update Intake Info into Excel Y Proceed to Waiting Area Take Next Chart from "To Be Seen for Treatment" Queue Bin Ready for New Patient Call Out PT Name and/o (Confer wit Translator a Necessary Wait to be Called and Escorted by Medical Professional Proceed Back to Waiting Area Ready for New Patient Take Next Chart from "To Be Seen for Psychosocial" Queue Bin Call Out PT's Name and/or ID (Confer with Translator as Necessary) Entry into Clinic Observe Pre-Registration Signage Put on mask (self + family members as necessary) Lodging Observing fever? Y PATIENT+FAMILYADMIN/CLERKMEDICALWORKERPSYCHOSOCIALER Require belongings bag? First Visit or Follow-Up? Follow- Up N Put belongings in bag(s); carry bag(s) throughout clinic Y N (1) PRE-REGISTRATION (2) REGISTRATION D Proceed to Registration Queue Receive patient First Visit Start New Charting Folder Take 2 ID Stickers; Place 1 on Chart and 1 on Bracelet Dialogue with PT; Input Intake Info into Excel Ask for Name Find Chart in "Follow-Up" Bin (Alphabetical; Last Name) Patient still has ID Bracelet?
  • 48. Treatment Area StaffInventoryProcess Station Step Purpose For medical staff conducting assessments: • Clear separation from waiting area and other treatment areas for privacy reasons • Easy access to medical supplies & cleaning Required: • 2 x medical professional (RN, NP, and/or MD) (Medical staff must have at least 1 female on shift at a time for cultural sensitivity) Required: • Primary PT assessment Possible escalations: • To MD (consult call) • To EMS • To Psychosocial health • To Diagnostics 4 Treatment Required per station: • Bed for PT + 2 chairs • LP12 or AED + table • Crash bag • Biohazard container • Sharps container • Privacy (room / dividers) Treatment bed LP12 or AED Temporary dividers as necessary Chairs and/or table for supplies
  • 49. 24EMAT: Primary Care Clinic Setup Guide (Dec 2015) Pearson Infield Terminal Setup Gate 523: Flow of refugees disembarking from plane into terminal; walk through glass entryway to Gate 521 CBSA Officers on the lookout for communicable diseases to escalate to PHAC RNs if necessary PHAC RNs Welcome Centre CBSATerminals Gate 521: Welcome to Canada! Proceed to CBSA Waiting Area Service Canada EMAT CBSAWaitingArea
  • 50. Flow through Pearson (Detailed) Fit to fly? Y N DND HCPs: 1 x MD 1 x RN Staffed on plane Event Start IME Screening at Origin Point by DND Personnel Jordan/Lebanon 1.0 Board plane and travel to Toronto, Canada 2.0 Arrival at Pearson Airport 3.0 Disembark (Gate 523) 4.0 MD/RN identified for med assistance? N Y Proceed to receive primary care assessment @ EMAT EMAT Proceed to PHAC Quarantine RNs PHAC Quarantine flag for EMAT? N Y Proceed to CBSA Processing 5.0 Proceed to Welcome Centre (Receive clothing) 7.0 Identifies patients in need of assistance Placement arranged? Placement to pre-arranged location in Canada 8.A Proceed to Interim Lodging Site (ILS) 8.B Y N Self-identify for medical assistance? N Y Proceed to Service Canada (Receive SIN #) 6.0 EMS Critical? YN Exit to EMS (Peele Medics) Proceed to Next Station in Process (CBSA if not yet processed, or Service Canada if they have already gone through CBSA) CONTINUE ON EMS Critical? YN
  • 51. 70EMAT: Primary Care Clinic Setup Guide (Dec 2015) Inbound refugees will be gradually acclimatized to Canadian culture, but are expected to undergo a period of learning and education regarding acceptable practices and behaviour that may greatly contrast what is normal for them. Accordingly, all clinic staff are expected to exercise appropriate sensitivity, tact, and discretion in handling culturally sensitive scenarios that may arise. SITUATIONS REQUIRING ESCALATION: Call EMAT EOC: 1-800-680-7260 When in Doubt: Call EMAT
  • 52. Rolling with the punches — Info changing all the time — Lots of unknowns — Intense / urgent situation — Little time to manicure output — Unique design challenges (language + cultural + religious customs)
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  • 59. Stacey Newman | Shutterstock.com
  • 60. Mark Blinch | Reuters
  • 61. Nathan Denette | The Canadian Press
  • 63. Looking back — Service design is a powerful “lens” — Work within your constraints — Be thankful you live in Canada :) — If you want to get involved... #WelcomeRefugees
  • 64. Bernard Weil | Getty Images A Reflection on Canada’s 2015 Syrian Refugee Operation THANK YOU