In May of 2018 I joined the Innovation Office at San Francisco’s Human Services Agency. In my very first week of work I was pulled in to co-facilitate a series of service design workshops with the In-Home Support Services (IHSS) department. This is a government program that helps older low-income adults and people with disabilities to get access to a care provider so that they can remain safely in their homes. We gathered stakeholders from various positions and authority levels to do an end to end service mapping of the care provider experience.
Through this exercise we were able to identify key pain points in the provider journey and then brainstormed possible solutions. We identified a prioritized list of improvements our office would assist the IHSS program with.
As an innovation office we believe an important part of our work is creating measurable impact by constantly asking ourselves: How is anyone better off from our efforts? In order to successfully measure this, we need a baseline, so we identify several key metrics that speak to pain points and the overall situation. For this project with IHSS we discovered:
1.People were voicing frustration about not being able to speak to a live person because of our automated phone system
We received approximately 16,800 phone calls every month to our automated phone system, many of them repeat calls.
2.54% of providers reported non-English speaking language
We wanted to provide multilingual, culturally relevant support and content on our various channels
3.It takes on average 34.5 days for a care provider to go through our enrollment process and receive their first paycheck.
We wanted our care providers to get enrolled and paid faster.
Stepping inside — 3 Service Design Projects
Can I speak to a human?!
In January of last year, the IHSS care provider phone line was replaced by an automated telephony system. Providers, who often need to speak to a staff member to resolve complex payment problems or other issues that arise on the job, were being met with an automated phone system that did not meet their needs. We were receiving repeat phone calls from frustrated providers, attempting to find the right phone option that led to a live person.
We collaborated with IT and IHSS staff to re-design the phone system in order to immediately surface the option to speak to a live person, while still allowing them to access the automated options. We ran several working meetings with frontline staff to incorporate their input, helping inform the use of clear language and a more friendly flow.
After adding this new functionality to the automated phone system, the number of monthly phone calls dropped by 70% from ~16,800 calls per month to ~5,000 in 2018.
Two-way communication Design Research & Prototyping
Another pain point for care providers exists around their ability to easily receive status updates, request documents, and update their information. An average of 3,735 care providers visit our assistance center in person every month to resolve tasks or questions.
We wanted to imagine a way to address these pain points by opening up a two-way communication channel between providers and our staff. In order to do this, we facilitated a product discovery workshop where we invited staff members across various departments and job roles in IHSS and IT. Together we created a vision for a platform to assist providers. We identified the provider personas we would need to design for, mapped stakeholders, and created a prioritized list of features. Several concerns were also raised; A majority of our care providers do not speak English as their primary language, and computer literacy and access is a barrier for many.
Throughout this process, we encouraged discussion of a technology agnostic concept, while implementing a survey in our provider assistance center where we asked our users what their preferred medium of communication is. The results were very clear: 41% of respondents chose text messaging as their preferred communication method, more than doubling the next leading preference (email).
At this point, we quickly put together a prototype concept for a text messaging platform that could walk providers through their journey. This platform would connect to our database, pull the provider’s preferred language using their phone number, and communicate in their language. We quickly set up a phone line, text messaging tree, and personalized content. We conducted a series of user interviews with providers where we observed them using the prototype on their own devices and collected feedback about their experiences. Overwhelmingly, providers felt positive about the possibility of using text messaging to receive notifications and have a convenient way to send information, expressing enthusiasm around the time savings this tool would provide.
One provider said “I would use text messages because it’s convenient and saves me time. I prefer texting because I don’t need to come here [the assistance center], spend money on the commute, and even if I call I need to wait and someone needs to answer. This is faster.”
We are currently exploring ways of using this research to implement and scale a text-based solution for communicating with the public.
Group Orientation Prototype
Currently, we onboard our care providers through in-person one-on-one orientations where they sign required documents, are introduced to the program, and we answer questions. While giving one-to-one care can be effective, this model is very resource intensive for our program and causes two week long wait times to book an orientation.
While adhering to state mandates for face-to-face orientation, we helped move the onboarding approach to a group orientation model. The aim is to reduce the wait times for provider enrollment, free up staff time, and improve the quality of information that providers receive. We decided to prototype a group orientation by working with frontline staff and our partner organizations, : HomeBridge, Public Authority, and the Providers’ Union, to align around content, process, and new opportunities.
In these working sessions, we noted that after orientation, providers need to get their fingerprints done on their own time. Seeing as one of our partner organizations already provides low-cost fingerprinting services and would now be present at orientations, we worked with them to make their fingerprinting services available as well. By partnering with other our community organizations, we’re able to serve providers more holistically, expand their understanding of the IHSS ecosystem of services, and hope to create a space for them to connect with one another as well.
We ran three prototypes of the group orientation. The first, a dry-run where we worked out logistics, way-finding, and technology kinks. We assigned our own staff to play providers in order to mimic a real orientation. The second run, we invited a round of English-speaking providers and the final run was with a Chinese-speaking group. After each orientation we did a group reflection exercise or a retrospective to identify opportunities and resolve issues quickly. After these three runs, the staff felt ready to implement a new group model of orientation and the director was pleased with the effectiveness of our iterative approach and collaboration: “I have heard many positive reviews of the process and am so impressed with the speed and thoughtfulness of your approach to this endeavor.”
Natasha Jimenez, Service Designer — City of SF HSA Innovation Office
As a service designer for the Human Services Agency I see myself as an advocate for the voice of the front line staff and clients we serve, relentlessly bringing their needs into product and service design decisions. I conduct user research with the public, map our services across various departments, and design digital tools to improve the public’s experience. I work across various levels of leadership, from directors to frontline staff, designing solutions that range from step-by-step guides and user friendly online experiences to prototyping automated text messaging bots.
In my free time I enjoy creating public art about our connection to the natural world and one another, designing apps for equity, and also speaking about humanitarian design. I have led workshops at SxGood, meConvention, Code for America, and the United Nations World Humanitarian Summit.
Originally published at sfhsainnovationoffice.tumblr.com.