Design and Politics: SVA Works With the Camden Coalition of Healthcare Providers

This blog post was written by Natalie Balthrop, Producer at Zago— a strategy and design studio in Manhattan. She co-led a workshop with the inaugural class of the SVA Products of Design graduate students with Manuel Toscano, CEO at Zago. Below is the story of workshop and the impact the students’ work had.

“We have had a lot of people come in and out of our doors over the years. And none have captured the essence of what we do the way that you have. I commend you for that.” Dr. Jeff Brenner, MD Executive Director and Founder of Camden Coalition of Healthcare Providers, MacArthur Foundation Genius Grant Award Winner

This quote ended eight months of work from the first graduates of the Products of Design program at SVA. Their design interventions struck a chord with every department of the Camden Coalition of Healthcare providers. Here’s how we got there.

Last summer, Manuel Toscano and I met Jeff Brenner, Executive Director and Founder of the Camden Coalition of Healthcare Providers (CCHP), at a Complex Care Innovation Lab organized by the Center for Healthcare Strategies. CCHP is an organization that works to improve the care of Camden’s highest-cost, highest-need patients in the healthcare system. CCHP operates on a three-pronged theory of change fueled by data, engagement, and clinical redesign. By allocating resources in these three areas, CCHP works to improve the quality, capacity, coordination, and accessibility within the healthcare system with a patient-centered approach rooted in compassion and empathy. CCHP’s basic principle is that if you improve care for the sickest patients in the healthcare system not only will you improve the quality of life for patients, you will dramatically reduce costs. Brenner started this work when he began running the numbers around hospitalizations in Camden and realized that the sickest, most expensive patients were actually geographically localized. Data enabled him to find the patients that needed his services most and thus has been foundational to the organization.

After our first meeting at the Innovation Lab, Manuel and I spoke to Dr. Brenner about adding design capacity to the already progressive CCHP. Interestingly, CCHP is already quite advanced in using design processes in program development and organizational strategy. Inherent in their delivery model is the consideration of healthcare as a system where success means that all patient’s needs are addressed. For example, health is not a result of people being immunized and making their doctor’s appointments, but is an issue that encompasses social services, housing, community infrastructure, transportation, and so much more. CCHP designs its programs to address all of these patient issues.

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A photo from the streets of Camden, NJ Courtesy of Zago/2013)

Since 2012 when the Products of Design program began, Manuel and Allan had been in conversation about a workhop around Design and Politics, two subjects that are inextricably linked. Working with Dr. Brenner, CCHP, and Camden, NJ seemed like the perfect opportunity to explore these heavily weighted topics, especially considering healthcare’s recent political spotlight.

The healthcare industry is one of the country’s largest and fastest-growing industries. Recent reform with the introduction of the Affordable Care Act (ACA) has been one of the most hotly contested and polarizing pieces of legislation in the past decade. ACA aims to transform the cost, distribution, and delivery of healthcare services with the overarching goal of reducing cost and increasing access to care for millions of uninsured Americans. How, to whom, and at what cost healthcare is delivered is one of the most explicit ways that politics influences the design of complex systems. We aimed to explore all of these issues in our workshop with the students.

The workshop was designed over the course of three days starting with a full-day observation and immersion session in Camden. After a few preparation meetings in New York, all of us crammed into one 15 passenger van at 6am and headed for New Jersey. After a quick 2 hour drive to Camden, the students jumped into the morning routine as if they were part of CCHP’s staff.

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CCHP begins each morning with a check-in meeting wherein case managers and community health workers meet to discuss the previous day’s activities, status of patients, and the tasks planned for the day. Following these morning sessions some students shadowed Coalition workers in the field, while others spent time with the Diabetes Clinical Redesign program. Three students remained onsite at CCHP to meet with the data and program evaluation teams, an important group considering the role quantitative information plays in CCHP’s intervention and program design.

The students returned from the field and heard a presentation from Dr. Brenner about the role of design in fixing the healthcare problem. His provocative presentation stressed that healthcare is a broken system and needs outsiders to fix it - namely designers. Dr. Brenner believes the reason healthcare is broken is because the wrong people are being brought in to fix it. He posed questions like ”Why would we ask the same people to solve the problem that they themselves created? Why is that a good idea?” To Brenner the system is broken. Designers and others with disruptive ideas could radically shift how we think about the problem and create a solution to fix it. To end our morning with CCHP, we had a brainstorm with senior staff about their process and their work. This conversation was focused on their needs, and the challenges they face daily both individually and as an organization.

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Jeff Brenner speaks to the students about design’s role in healthcare.)

Our afternoon consisted of a deep dive synthesis wherein the students broke into three groups and shared their morning experiences, each of which was unique and valuable to this about possible design interventions. Together we mapped the system in which Camden exists. For example, one student mentioned that one of the reasons Camden fell into extreme poverty is because the city became isolated with the construction of two bridges that allowed travelers to bypass the city entirely. Camden was once the gateway to Philadelphia and now it is the city that you can drive over. (INSERT PHOTO: Bypass Camden shot) Another student shared that a CCHP staff member had revealed that there were no grocery stores in the entire city. A student on a field visit learned that one of the most pressing challenges facing case managers is that it is often hard to find patients because they do not have access to cellphones or a permanent address. How do each of these observations offer an opportunity for design intervention? How is each a system problem rooted in political structures? The afternoon in Camden ended in discussion and exhaustion, but enthusiasm for the potential of actionable design solutions that could help CCHP and the population it serves.

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When we returned to New York, it became clear that our work was just beginning. Three weeks later we met at the Products of Design studio at SVA for a 2-day intensive hack-a-thon of sorts. Everyone agreed that it was valuable to have a few weeks between our visit and dedicated time to create solutions. In Camden we had framed the problem of the city and the healthcare system, but at the start of our weekend in New York, we decided to pivot and focus on how an individual patient interacts and interfaces with CCHP. This shift allowed us to take a patient-centered and user-centered approach to this design challenge. It also provided us with an inherently empathetic perspective to how the patients engage with the (broken) system and where CCHP is currently working to fill the gaps.

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Though our process was collaborative, much of the time was spent with the three groups working to design interventions at specific points in the system. Organically, each group addressed a different point in the system, but each of the solutions was directly related to the other interventions. After the two-day workshop, the students had three, well-conceived concepts centered around 1) mapping the patients social network 2) building community through group care and networks and 3) transportation services that utilize graduates. Each concept was thought of from the perspective of multiple users: the patients, CCHP, and the system itself.

The students presented their interventions to four CCHP staff members in New York on February 4, 2014. When the students presented the cluttered and complex system map that charted the journey for a patient in the healthcare system in Camden, CCHP members gasped. Jason Turi, Associate Clinical Director and design enthusiast, immediately pulled out his phone, snapped a photo, and tweeted. When the presented ended, he was the first to comment and said: “I have never seen a map of our system before. I want to frame that and put it on our wall. This is incredible.” Following the presentation in February, CCHP invited the students back to Camden to present their interventions to the entire organization.

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On April 18, 2014, Manuel and I headed back to Camden with Zena, Matt, and Charlotte. Over lunch, they presented their work once again and received overwhelming praise. CCHP was incredibly complimentary of the student’s work and was enthused by their ability to think of solutions that were actionable, such as the creating a social network map of the patients and community group care. The third intervention, which centered around transportation, if implemented, could radically change the delivery of health in Camden and nationally. Such a solution would require policy shifts and an entire overhaul of a preexisting structure that provides transportation services. CCHP is excited to continue working with SVA and Zago to evolve and expand this group’s work. Having an outsider’s perspective with an empathetic design lens has enabled CCHP to see the organization’s work in a new light and envigorated the organization to use design thinking processes in their daily work. Healthcare is complicated and broken, but based on our eight months working with CCHP, it is clear that they are an organization that has the potential to help put it back together.

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