Principle 4: Design at scale
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Design in the public sector can seem a slower, more complicated affair than its private sector counterpart. However, each sector has its own unique values and pressures, terms to fulfill, and spaces to explore. While the private sector is pressured by a constant need for increasing profit and the short-term thinking that such a challenge requires, the public sector must respond to and support the public through long life spans, which means nurturing ideas that support planning ahead for decades of growth and change.
Case in point
The New Orleans VA Medical Center
The citizens of that famous city speak of “before the storm” and “after the storm” as markers of time and radical change in New Orleans. Katrina flooded the 50-year-old VA Medical Center (VAMC) in 2005 New Orleans, ultimately shutting it down and causing suffering to the city’s most vulnerable residents.
In 2016, the city reopened its VA Medical Center. When building this new facility, VA and its partners chose to plan for more storms like Katrina, instead of chalking it up to a once-in-a-century event. To prepare for other violent storms and flooding, the building has capacity to house people through electrical outages, and has a boat landing on the second floor. The planners anticipated that the building might be in use for another 50 years, and that those 50 years are full of unknowns. The result is a facility that works not only for the current healthcare of the approximately 70,000 veterans in the Gulf Coast region, but also the community surrounding the facility, and that community’s potential critical needs.
Public sector design
Public sector design means planning for all groups affected by the products, services, and systems we design. It is also inherent to our work that we make sure that groups of differing abilities, backgrounds, worldviews, ages, and practices are all able to access what public sector designers create. This means that the groups needed for research and testing are massive, but that need must be addressed if we want our designs to be useful and usable.
Precision; not exclusion
Due to this massive potential audience, design in the public sector can be intimidating. To get it right, to include everyone, to consider all the angles, are all pressures design teams feel throughout the design process. How, then, can a team effectively design for such a massive number of people as the entire public? To be successful, proactively and explicitly define the audiences for the team’s work. An important distinction here is precision in the audience’s definition of the product, service, or system being designed, not the exclusion of audiences to the design. Design teams in the public sector have to be fair and inclusive of all people, but if a design tries to solve problems for multiple, overlapping groups, it runs the risk of not functioning well for anyone. This means making designs that address precise problems for precise audiences, so teams solve problems well and thoroughly.
During the discovery phase, design teams define their audiences through the problem-framing process. In the design phase, teams may need to redefine their audience to a more precise scope, as the team ideates solutions based on the opportunities identified in the synthesis portion of discovery. This means acknowledging a diverse audience set, but designing for a precise group within that audience so that the product, service, or system solution functions well and, ideally, will clear the path for other design solutions to be made for the adjacent audience groups.
Case in point
VA’s Patient Advocacy Tracking System
The Patient Advocacy Tracking System (PATS) is not a glamorous software product. At its core, it is a data-entry system used by patient advocates, who are non-clinical service providers in VA Medical Centers. But its function is incredibly important. It’s intended to record complaints and compliments veterans have while navigating VA Medical Centers (VAMCs), and to track the paths to their resolutions, as well as the paths of compliments through to their delivery. The numbers generated by the PATS system are vital to the medical centers as a dataset, but those numbers, configured in various ways, return different results according to the audience’s values, assumptions and biases. For example, administrators use PATS to track performance; medical professionals use PATS to gather insights into how veterans and caregivers perceive their care, and patient advocates maintain all the numbers on the reactions of veterans to their care. Given this diverse group, when faced with a redesign, questions about these varied use-cases arose. Should the software attempt to answer all their questions and needs, or should it focus on working best for one set of participants? And, if for one set, whose values should be most supported in a redesign?
When preparing for just such a redesign, the Veterans Experience Office (VEO) and The Lab at OPM partnered to parse the data and define the audience. While part of the redesign effort was supposed to include an expansion of the resolution process to the different medical departments (also known as Service Lines) within a VA hospital, the research undertaken by VEO and The Lab showed that those service lines would not necessarily be able to take on this task, in addition to their normal medical work. In response to this research, the team then decided to design the system for the needs of the patient advocates, because they touch the system most often and would, according to the research, continue to manage the resolution process, and were willing to work more closely with the medical lines to enact any new procedures needed in the future.
The software interface now supports the patient advocates in their daily work, with a large, open text box for notes, the ability to search by name and last four digits of social security numbers, and the ability to have multiple cases open at the same time. While the system still allows healthcare providers to access complaints and compliments and be part of the process, and it still allows administrators to pull performance numbers, it answers the needs of the audience that interacts with it most often - the patient advocates. The PATS redesign is an example of supporting multiple participants, but highly defining one’s primary audience.
