Helping Commissioners Serve Their Constituents

US Department of Health and Human Services

Project Brief

The Office of Business Management and Transformation was asked by one of the HHS's strategic committees develop a new office within the Administration for Children and Families (ACF). Our team, consisting of myself, OBMT's innovation and design strategist, and an undergraduate business student, was brought on to lead a human-centered design approach to the project and to then provide the committee with a strategic "blueprint" for the proposed office.

Roles I played

  • Developed discussion guides

  • Conducted user interviews

  • Created and tested prototypes

  • Generated actionable insights

  • Informally presented insights and research to client prior to the strategic blueprint's development

"

I need to make sure I know what to tell him when he asks why we're doing it like this.

"

Uncharted Territory

Stakeholders at all levels were terrified of what failure could mean for their funding, productivity, and, ultimately, job. ACF was concerned that, if this project didn't work, they would lose credibility. I framed design research and prototype testing as a risk management strategy to help the strategic committee and ACF leadership understand the benefits and safety of taking this approach.

State level commissioners, directors, and employees were also afraid. At first, they were hesitant to participate in our user research because they were afraid that something they said could cost them their reputation and job. Once they understood our sincerity and intent, we learned just how deeply seeded their fear truly was. Time and again, we heard how commissioners and directors had been penalized for trying something new, thinking it would work based off of other cases and strong evidence, only to have it not go as planned. They had lost funding and received scary, reprimanding letters. Now, they were afraid to try anything outside of what was already a well established practice.

Persistent Fear

"

I do want to try new things, I'm just scared!

"

Uncharted Territory

Stakeholders at all levels were terrified of what failure could mean for their funding, productivity, and, ultimately, job. ACF was concerned that, if this project didn't work, they would lose credibility. I framed design research and prototype testing as a risk management strategy to help the strategic committee and ACF leadership understand the benefits and safety of taking this approach.

Research

Building rapport with users was vital to our research, but we faced pervasive skepticism as to both the sincerity and confidentiality of our efforts. Past experiences led many potential users to doubt that we had a genuine interest in hearing what they had to say and that their comments would not be used against them down the line. As a result, many declined participation or entered conversations with their guard up. Once rapport had been established, most conversations had to be conducted over the phone because of budgetary constraints. To ensure anonymity and to build trust, no photos or visual recordings were made during research. To begin all of our conversations, we explained who was on our team (many had never interacted with OBMT directly), what human-centered design is, and why they were so valuable to this process. From the start, we made it clear that they were the experts in the conversation, and that we were there to learn. Without understanding their experiences, we would not be able to recommend strategies for the office that would truly benefit them. As an intern, I was clearly a novice in the government, allowing me to ask questions that might have come off as silly or intrusive had my boss been the one asking. 

The majority of our user research centered around learning about the experience of being an employee within the health and human services system at a local level. What is the most frustrating part of the job? The most rewarding? I've heard about other people experiencing this, what has your experience been with that? Once they were confident in our sincerity and the confidentiality of our conversations, users from commissioners to social workers shared detailed stories and offered more information than we had anticipated getting. 

Overview

The office's purpose was to help commissioners create services that would enable constituents to achieve long-term economic independence. 

 

Our team delivered a strategic plan to the committee detailing key activities for the office to execute, specific activities and messaging to avoid in the interest of maintaining users' trust and participation, and personnel qualifications and character recommendations. The office would focus heavily on integrating programs, measuring outcomes, promoting collaboration, and providing commissioners with tools to innovate within their state.

 

Using human-centered design methodology was an uncommon practice for the stakeholders in this project, and accordingly our team worked to overcome systemic wariness towards the human-centered mindset. As a result of co-creation sessions and compelling storytelling, we were able to establish rapport with committee members and effectively overcome these potential obstacles.

Understanding

Learnings, observations, and quotations from our conversations with users were synthesized using a say/do/think/feel framework. Information from the four categories were then re-organized into thematic groupings that were developed into actionable, impactful insights.  

 

Our groupings and insights centered almost exclusively around systemic barriers to innovation:

  • Fears of failure, because the failure of an experimental program could cost the state funding in the future

  • Frustrations over the power dynamics between state governments and the federal government

  • Concerns as to how the proposed center of excellence might encroach on a state's autonomy

  • Lack of understanding at a state level of rules and regulations regarding funding provided by the federal government

  • Timidness of a commissioner hindered the whole state system's ability to innovate

Iterations

Key activities that the office could potentially execute were prototyped as storyboards and diagrams and were tested with users over video-conferences when in-person conversations were not possible. Activities and questions such as, "What happens next?" and "Where are you in this story?" helped us understand what users' expectations were of the office. 

As concepts were refined and added, storyboards became more detailed, and we were able to learn what were considered the scariest, most exciting, least welcome, and most aspirational aspects of the ideas we prototyped. Although we were unable to assess buy-in by sending mock emails, fliers, etc., we presented them to users during conversations and discussed them based on questions such as "What is your knee-jerk reaction to this?" and "What would have to be true about this event/service for you to sign up/use it?"

The concepts that generated the most excitement and conversation were those that:

  • Ensured the federal government would provide assistance when needed but...

  • ...Recognized that the state leaders knew what was best for their constituents and included constraints on the CoE to maintain commissioners' and control over innovation in their state

  • Encouraged risk-taking by eliminating the fear of repercussions

  • Provided guidance navigating funding rules and regulations, especially with a focus on understanding how to innovate within these constraints 

  • Promoted the break-down of funding silos

  • Created avenues for collaborating with other states, implementing successful programs across state lines, and establishing standards of excellence

Solution

The "blueprint" our team provided to the strategic committee and ACF detailed key activities for the proposed office, specific activities to avoid, and important qualities of prospective leadership. We recommended that the office, first and foremost, encourage healthy risk-taking by commissioners and directors. Strategies for doing this included:

  • Providing no-risk, short-term grant funding for trying new programming without fear of repercussions. Our strategy included an annual or semi-annual call for grant applications, with a few states being given funding for new programming each year. Applications would include rationale for the new programming, background supporting the proposal's strategy, and proposed methods for measuring outcomes. Most importantly, grantees whose plans did not lead to the outcomes they had expected would not be penalized and would be able to apply for new funding at the next call.

  • Giving commissioners and directors autonomy to ask for help as they saw fit, rather than having someone from Washington, D.C., come in to problem-solve on their behalf. Though ACF and the committee had originally come to us with the belief that a "SWAT team" approach - sending federal employees from the CoE in to states to provide assistance - would work well, our findings indicated the opposite and we noted this in our strategy. Instead, we designed a system of "federal navigators" to whom state leaders could turn for assistance when they wanted help. These navigators would be able to provide a broad range of consulting services, from problem identification, to program design, to guidance regarding innovation within the constraints of federal rules and regulations

The blueprint further discussed strategies that could be used to build rapport with users and alleviate fears of insincerity, as discussed above. Phrases such as "SWAT Team" instilled fear of an overbearing CoE and discouraged state leaders from wanting to engage with the office. Messaging about the CoE needed to reflect a culture of support, trust, and encouragement. Along with this messaging, we gave recommendations regarding important qualities of a leadership team for the office. Our strategic blueprint emphasized the importance of the CoE's leadership being neutral parties, above reproach. Leaders needed to be able to take pushback from the federal government for any "failures" at a state level that came as the result of trying new programming, providing a physical and emotional buffer for states. Furthermore, CoE leadership needed to be willing and able to defend risk taking, understanding and advocating for small failures as learning experiences, then helping states grow from these learning experiences to ultimately improve programming .

 

Additionally, we detailed core values of human-centered design methodology, such as iterative testing of concepts on a small scale, taking "failures" as opportunities for continued learning, and strategies to ensure a continuous feedback loop with users. We viewed general lack of familiarity with design thinking as a potential barrier to the CoE's success and wanted to provide as much opportunity for growth as possible. Our team recognized how radical many of our proposals would be daunting to a risk-averse budgetary committee, so we emphasized framing small-scale prototype testing as a risk-management solution and included strategies for minimizing financial impact of prototypes. The blueprint further encouraged the CoE itself to be run as a prototype at first, starting with a few states, then tweaking and expanding as kinks were worked out and the office gained credibility and support.