Driving Impact with Human Centered Design at the U.S. Department of Veterans Affairs: Q&A with Erin Poetter Siminerio

Erin Poetter Siminerio is leading an experience design team at one of the largest U.S. federal government agencies: nearly 400,000 U.S. Department of Veterans Affairs (VA) employees provide health care services and benefits to 9 million Veterans, their families, and caregivers.??

VA is the largest integrated health care system in the U.S. and trains 70% of U.S. doctors.?

We recently had the chance to speak with Erin about how VA is improving customer experience (CX) for Veterans by using human centered design (HCD) and design thinking methods to improve access to VA health services and benefits. She told us about her team’s “design doing” mindset, the importance of data-driven storytelling, and how sometimes “just taking a breath” helps her be a better, more empathetic leader.?

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Kelly O’Connor: We know VA has been using HCD and design thinking methods for several years now to improve Veteran experience when interacting with VA, but we’ve recently heard your Veteran Experience Office (VEO) team talking about “design doing.” Can you tell us more about that??

Erin: Because we have been studying Veteran experience for years and have conducted more than one hundred studies, we have a lot of insight into what makes or breaks the experience. We are spending more time figuring out how to bridge our design research insights into action and tangible design solutions. This is design doing.??

When researching with partners, we assess for opportunities to move into a design phase or workshops that can help them prioritize their improvement based on customer needs—not just what the business thinks. We want to get to the point where there are at least some concepts, solutions, or a prioritized road map and leave them with something that's actionable versus a list of interesting insights about their program or service. We want to make it more tangible.?

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Kelly: That’s great, because a common thing we see at clients across industries—not just government—is that ethnographic research gets done with users but ends up being just a poster in an office or a document that never gets used by decision makers and product teams to make things better.??

Can you talk about the results you’ve achieved with “design doing” and how your work has made things better for Veterans, their families, and caregivers??

Erin: One example was with VA’s Emergency Medicine services. We had a great business partner, led by Chad Kessler, with us throughout the project. One interesting thing we found from talking to staff is a lot of focus was on improving backstage processes. Veterans told us that they understand wait times are sometimes unavoidable, but they want to understand the reason for the wait time.????

VA staff were working diligently on several process improvement initiatives to shave time off waiting and improve triage, but people were still waiting without much information around where they were in the process and when they might be seen.??

We found a misalignment between the focus of staff on improving “internal processes” and were able to shift to a focus on Veteran needs while waiting. There wasn’t enough transparency and people did not know how long they were going to wait. So, we collaborated in workshops and developed a solution that delivers key information and shows who is urgent and where individuals are in the queue. We found ways to share this with Veterans while still respecting patient privacy, and this helped Veterans and VA front desk staff be on the same page.???

That project is now in pilot, for instance. We’ll test and learn if this improved the experience and build from there.?

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Jerry: That’s such a great story Erin. At BCG we always try to tell compelling, data-driven stories about impact.??

I know your VEO team has deep expertise and capabilities with survey data, including the roll out of Veterans Signals (VSignals) surveys in 2017. Those surveys collected 8.7 million digital responses from Veterans with feedback on the way VA provides care, benefits, and services. Can you tell us how your team approaches storytelling with all this survey data??

Erin: We hired a storyteller who’s creating compelling stories about our projects—not just in terms of what we learned, but things like “How did it go?” “What were some things that were surprising?” and giving an arc of the project versus just numbers of how many people we spoke to and what they told us.??

We are mining the hundreds of projects we've done and are working with the Chief Technology Office to get all the data in one place and tagged using agreed upon taxonomy so that it’s searchable and accessible to not just our research team, but others across the department who are working to improve Veterans’ experience. Mining that data saves time and accelerates outcomes.??

Surveys are a good source of data, but it’s important to supplement them with human-centered design research and tools. No survey can be the answer to all your questions; surveys are great for finding the signal, but you will only get data on the questions you’re asking. There’s no conversation or opportunity to ask “why” someone feels the way they feel.??

There’s also already so much information out there to make use of. You don’t need a new survey for every question; you just need to know where the data is, get your hands on it, and mine it. Reuse what has already been collected.??

When you have a problem and you are looking to solve it, I highly recommend starting by talking to someone else about your problem to gain a fresh perspective. So often people jump to solutions like “we need an app for that” or “we need to ask Veterans about that” but the time would be better spent asking “why” or thinking about who else has a perspective on this that I can learn from. Understanding what’s already happening in a space and what data already exists is so important before we start collecting more data.???

Kelly: Many people in need of government services may not have high-speed internet access. Can you tell us how your team thinks about digital equity and uses an omni-channel approach to provide different modes of access to services—including digital, call centers, and in-person??

Erin: It's a real challenge, and part of it is the way we’re organized. It can make it hard to create an omnichannel experience, and it sounds like everybody’s trying to do this right.?

The systems don't always talk to each other, so you can't jump from one channel to the next, which can be frustrating. We’ve all been there—being on the phone, telling your story, and then getting transferred and having to start all over again. That's a systems problem.??

Silos are also a problem. The CTO’s office may own the digital front door—everything that goes on the website and the apps. But people calling without internet access are connecting with the call centers, which are operated by a different part of VA.? With all these separate interactions and business lines, you have to make sure everyone works together.??

From a progress standpoint, we've made it so much easier for people to interact on the website. But the bouncing between channels, longitudinally following a customer, understanding their interaction history, and personalizing recommendations based on their needs is something we need to work at more. We want to see if they attempted to go online first and then had to call because they couldn't get the transaction completed.?

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Jerry: Do you have any other recommendations for other government agencies getting started with design doing??

Erin: We’re starting to do a lot more of it. Our bread and butter have always been discovery research—it’s almost our front end in a way, since it drives everything else. But you have to do it with the people you’re designing for and in a way that establishes buy-in, partnership, and trust so they want to stay engaged and see solutions come to life. Building that trust takes time and developing implementation-ready solutions that are embraced also takes change management and lots of piloting, testing, and refinement.??

To get started with design doing, you have to figure out what else is going on before you start making something new. You don’t want to start building something and then find out halfway through that there’s another team working on it. This means taking the time to understand what else is going on and scan the larger surroundings.?

You can only do that by knowing the right players and having those conversations, which is why we have more than 100 years of VA experience on our in-house design team. Our staff knows how to navigate VA to bring the right players to the table.??

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Kelly: Do you have any other strategies that have helped you throughout your career? ?

Erin: It can be challenging reacting to legislation while everyone’s scrambling and setting up work groups. People do this because they feel that they are under tremendous pressure to start making progress. I was on a call one time and got really frustrated and a colleague put a post-it note on my desk that just said “Breathe.” Period. I’ll never forget it. We have to slow down to go fast and make sure we are working on the right problem and with the right people, and that we have the right information to avoid duplicating efforts.?

We often have people who want to quickly and completely overhaul things, and I can be an inpatient person sometimes, too. But by jumping ahead, you skip some of the most important parts of the processes while burning a ton of resources.?

Nothing is ever fixed overnight. In my experience, the best work happens when people slow down, think things through, and just breathe.?

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Erin Poetter Siminerio is a Chief Design Officer at U.S. Department of Veterans Affairs?

Kelly O’Connor is an Associate Director at Boston Consulting Group?

Jerry Ronaghan is a Managing Director at Boston Consulting Group?