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Pascal Soboll: Moving beyond lucky design and systems thinking

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Design is shaping the world. Many examples illustrate that designers can change the world for the better. We are entrusted with more and more complex challenges and develop ever-novel approaches. Nowadays a plethora of design discipline exists and it seems fitting to clarify what it is that unites the designers today to then discuss how we can connect design to other fields better in order to maximise the impact of our work. One field that is proving a particularly rich complement to design is Systems Thinking, which essentially studying the interdependencies between elements in complex structures. While design thinking is a bottom up approach, systems thinking can supply the big picture context. Combining the two allows us to be more targeted in how we apply our design efforts.

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Pascal Soboll: Moving beyond lucky design and systems thinking

  1. 1. Inspired by people‚ designed for impact. Moving beyond lucky – design thinking and systems thinking
  2. 2. 2 portrait of grandma soboll
  3. 3. 3 We’re taming the increasing complexity of today’s world with the timeless simplicity of good design.
  4. 4. 4 Design Thinking Design-driven Innovation Experience Design Digital Design Industrial Design Service Design What is it that you actually do?
  5. 5. 5 Design Thinking Design-driven Innovation Experience Design Digital Design Industrial Design Service Design Systems Thinking What is it that you actually do?
  6. 6. 6 Design Thinking Design-driven Innovation Experience Design Digital Design Industrial Design Service Design Systems Thinking What is it that you actually do?
  7. 7. 7 2 Projects
  8. 8. 8 Brief: “How might we fight child obesity by 
 getting kids to move more?”
  9. 9. 9 UNICEF Kid Power Giving kids the power to save lives
  10. 10. Daylight Confidential UNICEF Kid Power Giving kids the power to save lives
  11. 11. 11 Challenges are becoming ever more complex and intractable
  12. 12. 12 Brief: “How might we make Obamacare viable?”
  13. 13. 13 The Problem
  14. 14. 14 Users are a crucial piece of the puzzle – one of many. 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 Centric members. Number of ED visits, inmember stays and claims dollars compared to averages. 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. 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 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 TESTABLE MOMENT MEMBER ACTION PROVIDER ACTION MEMBER ABILITY TO TAKE DECISION COLORS DENOTE Assess membe CENTRIC MEDI CAL BE H AVIORAL SOCIAL
  15. 15. 15 But we need to know more to move beyond lucky
  16. 16. 16 Three key benefits of systems thinking
  17. 17. 17 1. Gain holistic view, 
 understand patterns (system)
  18. 18. 18 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 O GOVERNME REPRESENTAT 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 
 VENTS USERS
 OM RENTING A HOME UNSTABLE FAMILY DYNAMICS LEAD TO PSYCHOLOGICAL PROBLEMS 1. Gain holistic view, 
 understand patterns (interconnectedness)
  19. 19. 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 health Causality Loops Missed medical appointments No credit
  20. 20. 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. 21. 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. 22. 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. 23. 23 1. Understand patterns 2. Find points of leverage 3. Track impact step-by-step
  24. 24. 24 Is systems thinking the new design thinking? 24
  25. 25. 25 Dealing with complex challenges Trusting in process Iterative COMMONALITIES Systems Thinking and Design Thinking
  26. 26. 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. 27. 27 Combining both Define opportunity Create Solutions Track Impact Iterate Design Thinking Systems Thinking
  28. 28. 28
  29. 29. 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 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 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 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. 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 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. work for state services. Centric Dashboard Centric Dashboard CENTRIC SERVICE EXPERIENCE MAP Centric 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 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 Criteria Centric 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 MEDI CAL BE H AVIORAL 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. 30. 30
  31. 31. Pilot launching next week. 31
  32. 32. Inspired by people‚ designed for impact. SYST E M S P R AC T I C E Handbook of Systems Thinking (Social Innovation) www.daylightdesign.com/news pascal@daylightdesign.com

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