4. Design at scale
4.1 Plan for long-term use
Differences in need
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 the long life spans we now enjoy, which means nurturing ideas that support planning ahead for decades of growth and change.
Building resilient buildings: the New Orleans VA Medical Center
In talking about New Orleans, one cannot avoid talking about Hurricane Katrina in 2005. The citizens of that famous city speak of “before the storm” and “after the storm” as markers of time and radical change. Katrina flooded the 50-year-old VA Medical Center (VAMC) in New Orleans, ultimately shutting it down and causing suffering to some of the city’s most vulnerable residents.
In 2016, the city reopened its VA Medical Center. In building this new facility, VA and its partners chose to plan
for more storms like Katrina, instead of chalking it up on a once-in-a-century event. In order to plan for other
violent storms and flooding even, the building features bed capacity for housing 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 itself and that community’s potential, critical needs.
4.2 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 to be sure that our designs are 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, teams must proactively and explicitly define the audiences for their work. An important distinction here is precision in the audience definition the product, service, or system being designed, not exclusion of audiences to 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 product, service, and system solutions based on the opportunities they 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.
VA’s Patient Advocacy Tracking System (PATS)
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: to record complaints and compliments veterans have while navigating VA Medical Centers (VAMCs) and to track the paths to their resolutions and the paths of compliments through to their dissemination. 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 themselves, who are charged with keeping all the numbers on the reactions of veterans to their care. Given this diverse group, 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?
In preparing for just such a redesign, the Veterans Experience Office and The Lab 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 decided to design the system for the needs of the Patient Advocates themselves, because they touch the system most often and would, according to the research, would continue to manage the resolution process, and were willing to work more closely with the medical lines to enact the new procedures as needed in the future.
For this reason, the software interface The Lab designed focuses on the needs of the Patient Advocates in their
daily work: a large, open text box for notes; 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 will still allow healthcare providers
to access complaints and compliments and be part of the process, and it will still allow administrators to pull
performance numbers, it answers the needs of the audience that interacts with it most often - the Patient
Advocates. Because of this, the design team chose the Patient Advocates as the primary design audience for this
work. The system would allow other audiences to get what they need from the system, but the system is designed
primarily around Patient Advocates' needs, as the primary participants in it. In this way, the PATS redesign is an
example of supporting multiple participants, but highly defining one’s primary audience.