Service Design for Government
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Balancing Patient & Employee Experience to Improve Veteran Access to Care

Fostering a Veteran-Centric Experience

Veteran Affairs’ (VA) ability to prioritize the customer experience of our Veterans is crucial to meeting its objective of “serving and honoring the men and women who are America’s Veterans,” One of the key ways VA successfully achieves its mission is by providing timely access to specialty care services. However, the most significant challenge to providing timely access to care to Veterans is coordinating between primary and specialty care. This includes prerequisite appointment requirements and specialty care consults which are a major factor in guaranteeing patient safety and quality of care.

The VA’s Optimizing Healthcare Value Program (OHVP) was tasked with identifying pain points that affect access to care and evaluate best practice solutions. OHVP engaged Technical Assent to help bolster Veterans’ access to timely treatment by uncovering key institutional knowledge within VA, defining best practices, and sharing findings to other VA sites.

Dissecting Costly Failures in the Consult Referral Process

Our team supported OHVP in completing qualitative data gathering and quantitative data analysis through two key avenues: informational interviews and a Healthcare Failure Modes and Effects analysis (HFMEA). We also performed virtual site visits that consisted of information-gathering sessions with primary and specialty care providers. The same issues that surfaced during many of the information-gathering sessions with providers were further confirmed by the analysis of the consult referral process. Existing processes, policies, and procedures combined with staff-related challenges to complicate the overall case management process that led to delays to Veteran care, namely provider fatigue, burnout, and increased turnover.

We also discovered that primary care providers (PCPs) often send Veterans for specialty consultation without the prerequisite testing information necessary to diagnose or address the issue. This is due to inconsistently defined and applied business rules around which parties are responsible for completing what diagnostic testing required for specialty care consult referrals, staffing and resource constraints that result in overworked providers on both sides, and disagreement on who’s responsible for what diagnostic testing. This resulted in specialty care providers discontinuing or canceling consults due to the lack of necessary diagnostic information and completed prerequisite testing requirements. In fiscal year 2021, the VA saw 28% of nearly 12 million outpatient consults get canceled or discontinued – not only does this significantly impact the veteran experience, it creates a loop of wasted time and effort on all stakeholders that may result in Veterans ultimately losing trust in the process.

Developing an Enhanced Operating Model

Technical Assent partnered with the VA Pittsburgh Healthcare System (VAPHS) to develop an optimized operating model to address access issues while referring Veterans for specialty care services, now dubbed the Complex Case Management Hub (CCMH). Our project team designed an improved care team model, built a business case for the CCMH model by quantifying the value of its benefits, and generated the tools and resources that an interested site would need to roll out the CCMH.

The CCMH’s design focuses on improving the Veterans experience when transitioning care from primary care to specialty care by optimizing the consult referral process. The process now alleviates barriers that providers face when submitting, triaging, and completing specialty care consults. Instead of the PCP bearing the burden for completing the diagnostic testing required to submit a consult referral to specialty care, the CCMH team takes on the full responsibility for performing any prerequisite testing and delivers a complete care package with all of the information required for the specialty care service to accept the Veteran as a patient. This eliminates the administrative task of ordering, tracking, and coordinating diagnostic testing for PCPs, while also preventing specialty care services from receiving non-useful consults that take time away from providing direct care to Veterans in their clinics. This has resulted in improved clinic capacity, improved provider productivity, and shorter wait time for both primary and specialty care appointments. In short, there has been a reduction in volume – and the associated costs – of Veterans being unnecessarily sent outside of the VA system to receive care.

Creating a Win-Win for Veterans and VA Providers

Our work is centered around the ultimate user experience for all stakeholders and helping get to the root of the problem through human-centered design. By developing a solution primarily focused on creating an easier process for PCPs, it resulted in improved care for Veterans and an improved employee experience.

How do you balance both the experience of your customer and that of your employees when designing a solution?

Hardwiring VA with Customer Experience Mindsets and Skilled Practitioners

Creating a Culture of Design Thinking

A focus on exceptional Customer Experience and improved service delivery is how the Federal Government ensures an effective, equitable, and accountable Government, and it’s how VA lives its core values and mission. To reach its CX (Customer Experience) goals, VA’s Veterans Experience Office is building the VA Customer Experience Institute (CXi) with the goal of hardwiring a CX-mindset to improve service delivery culture. This includes instilling organization-wide standard CX practices and collaborating with colleagues and the Veteran community to create better products, services, and experiences for all its customers. 

Technical Assent and the VA CXi team have partnered to design, develop, and implement expanded learning opportunities across VA in the form of an industry-standard educational platform for VA employees to gain awareness, understanding, and new skills in CX and HCD. CXI teaches best-in-class methods and tools with a VA-centric focus. It uses case studies and examples that are unique to VA to ensure the material resonates strongly with VA’s mission.

Through a set of formalized curricular programs taught by trained facilitators, VA employees will understand why, when, and how to apply CX principles and Human-Centered Design (HCD) methodologies to their work. This enables VA employees to confidently practice and lead CX efforts while connecting with each other to grow a community to share ideas, best practices, and challenges. 

Based on the VA CXi HCD Certification Roadmap, the CXi program aims to create an experience defined by the following dimensions. The pilot is the first opportunity to evaluate the program’s performance based on these six elements.

CXi aims to expand and initiate the practice of Customer Experience across VA, up-skill VA employees, set organizational and standard practices, and hardwire a CX-oriented mindset into the products, services, and experiences that we create with VA’s customers. This work provides an opportunity to standardize HCD practices across VA and connect VA employees across the organization. Building a new culture and mindset helps change and create a new approach to problem solving. 

A Customer Experience Mindset

Within CXi, VA employees will work directly with Veterans to understand their unmet needs and create relevant solutions that center around them. The program encourages employees to approach their work with the customer at the center by applying the following mindsets:

  1. Take your customer’s perspective
  2. Solve the right problem
  3. Embrace Uncertainty
  4. Get feedback early and often
  5. Empathize with your customer

Pilots and Progress

Starting this fall, CXi will  offer the Certificate Program, which is a set of structured courses teaching the fundamentals of HCD and CX through virtual interactive lectures and activities. There were 21 Certificate graduates from the pilot program. Looking toward the future, the team will add on a Fellowship Program that consists of a group of CXi Certificate-holding VA employees who work together and apply HCD and CX knowledge to a real-world project. 

“I’m already using this material in my own workplace and passing it on to other people.” – VA employee

“I liked the experiential way you demonstrated the tools. I feel like I will retain the information because of how it was taught.” – VA employee

CXi aims to be the first of its kind in the federal government, creating a like-minded community of people within VA and investing in employees so they are able to offer the best services for Veterans and their fellow co-workers.

How do you reach across silos within your organization? What mindsets and standard practices have made it easy to provide your customers with the best experience?

Using HCD to Reimagine Veteran Healthcare

Breaking the Status Quo

In the wake of the global COVID-19 pandemic in 2020, the “Reimagining Veteran Healthcare” project set out to not only study what has changed about health care for Veterans during the pandemic, but also investigate what might change to better anticipate Veterans’ needs of the future. This inflection point was an opportunity for VA to drastically rethink how to meet evolving patient expectations and a changing population of Veterans.

This vision for the 20-year future of VA emerged from research with Veterans, Caregivers, front-line staff, healthcare experts, and VA leadership. Starting with the core users of VA services yielded a web of opportunities spanning from discovery and design to technical development, prototyping, piloting and implementation —utilizing the full range of Human-Centered Design (HCD) methodologies, tools, and approaches. 

While VA has several ongoing and near-future transformational programming in the works, there is a large gap when considering truly transformational future opportunities. This is where Reimagining Veteran Healthcare stepped in. Our team from Technical Assent and Deloitte had a goal of developing breakthrough, nonlinear innovations of service delivery models to create or capture markets, services, products, and customer segments that have yet to exist.

Putting Veterans at the Center

To keep Veterans at the center of our work, the team conducted ethnographic research with 100+ stakeholder interviews (virtually and in-person) with Veterans, clinical providers, familial caregivers, subject matter experts, and other key VA staff members. These helped the team ​​uncover pain points, bright spots, and/or validate our assumptions about the current state of Veteran healthcare, understand the post-pandemic priorities and behaviors of different populations of Veterans, and inform several transformational opportunity areas. 

“[I define health as] having the ability to accomplish all the things that I want to do in my life […] without any hindrance from medical or monetary or any of those things that naturally get in the way. The quality of things I am consuming in life. It’s the total of all those things.”

“If I could just visit one entity, one website, have everything available to me on ONE Dashboard or profile. If it was tailored to me and what I went through it would be so much more helpful.”

“It’s symptoms first, then based from symptoms, give prescriptions that alleviate those symptoms. The immediate question is always ‘What can I give you?’ Well, I don’t want a medication. I want to solve why it’s hurting in the first place.”

Developing Customer-Driven Solutions

Based on the insights that emerged from conversations with 250+ stakeholders –including Veterans, caregivers, and front-line staff, consensus was found around three critical priorities for VA’s future:

  1. Redefine Veterans’ initial encounter with VA – VA has a critical opportunity to elevate health as a priority with Veterans during and following transition. Connecting proactively with personalized tools can create a seamless transition for Veterans to join the VA following active duty.
  2. Deepen ongoing customer service efforts and engagement – Veterans feel the fragmented nature of the VA. By creating a backend system that puts Veteran health records, feedback, and preferences in one place, VHA can provide a more seamless front-end experience while empowering employees to own each individual interaction and overall health journey.
  3. Extend the envelope of care – More than ever, Veterans expect care when, where, and how they want it. COVID-19 highlighted an opportunity for VA to extend care beyond its walls and broaden its definition of health and healthcare delivery.

Across these three central opportunities, 11 solution concepts were developed that allow VA to create transformational change for Veterans. These solution concepts are rooted in the Veteran experience, taking an outside-in look at what’s needed for VA healthcare delivery. Currently, the team is partnering with VAMCs to pilot and iterate on the solution concepts and help Veterans access VA care when and where they want it in the future.

How do you keep your customer at the center of your work? What opportunities are there to think outside the box to anticipate future customer needs?

A Tale of Two Service-design Teams

In addition to our regular work for government clients, we sometimes take on special projects. Last year, we facilitated these two workshops that were very different but also oddly similar. Watch the video to find out why and who these workshops were with!

About Technical Assent

Technical Assent exists to build high-performing government service organizations—government-to-citizens (G2C), government-to-government (G2G), and shared services. Our approach is unique in that we improve service performance from the bottom-up, starting with customer experience. We use that insight to design and modify the talent, tools, and technology that deliver government services to each customer.

  • Experience Design. We use service design-thinking and human-centered practices to refresh customer experiences and build relevant solutions
  • Solution Implementation. We implement viable solutions within scope, budget, and schedule and equip agencies to sustain the capability
  • Service Management. We leverage customer insights and performance data to optimize services, continually improve, and seek new opportunities

Video Transcript

In addition to our regular work for government clients, we sometimes take on special projects. Last month we facilitated these two workshops that were very different but also oddly similar. 

Washington, D.C. Service-Design Team 

Our D.C. service-design team facilitated nearly 100 defense professionals in identifying new ways to use existing capabilities in the Department of Defense. This workshop used design-thinking methods to help subject matter experts and operators learn how DoD can better secure acquisitions in support of operations.

West Coast Service-Design Team 

Our West Coast service-design team coached a local Girl Scout troop in earning their Product Design badge. These young ladies were seeking novel ways to keep lunches warm at school. They planned and facilitated the whole effort themselves using design-thinking methods from the LUMA Institute. 

Sometimes we’re helping to solve problems for the world’s largest military while other times it’s about teaching future generations how to be confident in their creativity. But despite the differences in age and project scale, both teams were outcome-focused and we used many of the same tools and techniques.

In the end, we were able to help both of these groups of people envision something that doesn’t exist today and set them on a path to making the vision a reality. It’s yet another reason our field of work is so fulfilling. 

Inspirational Quotes for Government Service-Providers

Many of the widely circulated inspirational quotes on the internet relate to private sector business. Our clients, however, are public sector employees and government leaders, and the work we do for them centers around customer experience, service design, and our innovative approaches to both.

At least once a month, we like to share an inspirational quote on our company LinkedIn page and we always select quotes with our government clients in mind. After doing this for several years, we’ve amassed a nice list of inspirational quotes for government. The following is a list of our favorites. 

About Technical Assent

Technical Assent exists to build high-performing government service organizations—government-to-citizens (G2C), government-to-government (G2G), and shared services. Our approach is unique in that we improve service performance from the bottom-up, starting with customer experience. We use that insight to design and modify the talent, tools, and technology that deliver government services to each customer.

Experience Design

We use service design-thinking and human-centered practices to refresh customer experiences and build relevant solutions

Solution Implementation

We implement viable solutions within scope, budget, and schedule and equip agencies to sustain the capability

Service Management

We leverage customer insights and performance data to optimize services, continually improve, and seek new opportunities

Two men use HCD techniques to review a new app as part of the DevOps process

Integrating Human-Centered Design with DevOps Will Deliver a Better Customer Experience

Software development teams are built for agility and speed. Once solutions are deployed, DevOps teams watch how customers interact with the application and use it to solve their problem. From this post, cross-functional teams can spot unexpected customer behaviors and monitor system performance. If an anomaly is detected, they can act quickly and collaboratively between developers (code writers and testers) and IT operations (responsible for keeping the applications running optimally). 

DevOps teams are part of a bigger service operation team that works toward delivering an exceptional customer experience. After all, every service organization wants its customers to see the organization’s  solution as the best, resolve customer issues quickly, and be first of mind if the customer faces similar challenges again in the future. But like any one part of a bigger service team, DevOps teams’ view of customer challenges is limited and their focus is addressing the observed customer problems as quickly as possible. 

DevOps teams must optimize for speed in ways that preserve connections to customers. This is necessary to fully address the issue the customer is experiencing today and to better understand the larger problem  the solution addresses for the customer. If customer-driven discipline is not built into every DevOps cycle, the service can suffer from a slow erosion of the value that comes from customer dialogue. 

Human-centered design (HCD) is a body of techniques that explicitly places customers first. It seeks to understand the outcome the customer is trying to achieve and the various alternatives and approaches customers employ to get their desired result. Integrating HCD into the DevOps cycle—or CustDevOps—streamlines service operations and DevOps processes while increasing the customer’s perceived value of the service. 

HCD frames customer outcomes in business terms 

HCD starts with the customer and the results they are trying to achieve. It also accounts for the capabilities of service providers. The best solutions emerge where the interests of both the customer and the service provider align. HCD frames the customer outcome and the challenges they face in achieving their outcome in business or mission terms. It provides the business or mission opportunity to make this issue urgent and compelling.

HCD thrives on customer feedback and validation 

From the earliest stages of prototype development, DevOps teams benefit from customer feedback. Understanding that time is of the essence, capturing immediate customer input in each increment can help shape the solution. HCD teams must be creative in how they capture customer feedback and account for the lead time of recruiting and sustaining a community of engaged testers.

HCD grounds automated performance data 

DevOps teams build performance metrics into deployed solutions so they can immediately understand how well the new functionality enables the customer to achieve their result. Ongoing dialogue with customers complements automated performance data feeds to establish empathy and understand why customers are responding they way they do.

HCD looks at the whole experience 

IT professionals are susceptible to the saying “to a hammer, everything looks like a nail” and may view every customer issue as something a technology can fix. The reality is there are many other complex reasons that customers struggle to achieve their outcomes beyond just their interaction with a technical solution. HCD seeks to understand the customer’s perspective in the context of the whole experience and can help solve non-IT problems that will ultimately help IT work better.

HCD provides a continuous thread so the voice of the customer is resonant in each part of the DevOps cycle. Building HCD discipline into each step ultimately helps customers achieve their desired outcomes faster which in turn helps DevOps teams focus on new features.

Try Our Automated Customer-Experience Self-Assessment for Federal Government

A map that shows a starting point and an ending point

To aid government agencies in fulfilling the new customer-experience requirements from the Office of Management and Budget’s Circular A-11, we have designed a free, automated CX assessment tool for government employees.

Circular A-11 (Section 280) applies to federal agencies designated as high-impact service providers. These designated providers have specific obligations that begin in early 2019. This includes the requirement to conduct an annual CX self-assessment and submitting a CX action plan.

Even outside of OMB’s specific requirements, our CX assessments are a great way to improve your office’s performance and customer satisfaction–whether your customers are U.S. citizens, government employees, private industry representatives, or other government agencies. Improving CX is is a measurable way to improve performance even for programs not designated as high-impact service providers.

These A-11 requirements, along with the Federal Agency Customer Experience Acts of 2017 and 2018, reflect a new priority in government. Being a service-design company founded on the idea that U.S. citizens should have the same high expectations of government service as they do customer-centric, innovative private companies, this is a trend we wholeheartedly support.

Our Standard Assessment is an automated version of OMB’s assessment that includes a report with a graphical interpretation of your score. We are also in the process of finalizing our Enhanced Assessment, which will be more thorough than the OMB assessment and the report will give you customized recommendations for building your action plan.

Email us at getstarted@technicalassent.com if you would like to be added to the notification list once we activate our Enhanced Assessment in early 2019.

airplanes take off on a runway

Technical Assent joins FAA’s eFAST contracting vehicle

We are excited to announce that we have been accepted to the Electronic Federal Aviation Administration (FAA) Accelerated and Simplified Tasks (eFAST) contracting vehicle. The FAA divides eFAST work into functional areas and we now hold master ordering agreements in the following areas:

  • Business Administration and Management
  • Computer/Information Systems Development
  • Computer Systems Support
  • Documentation and Training

 

eFAST is the FAA’s preferred contracting vehicle for small business contracts. eFAST streamlines the procurement process for all stakeholders using a web-based acquisition tool and automated workflows compliant
with applicable FAA standards.

Any FAA program management office (PMO) and contracting officer (CO) can use eFAST. For details about doing business through eFAST, visit the FAA’s eFAST page.

“We are eager to serve the FAA through eFAST,” said John DiLuna, President and CEO of Technical Assent. “Each new contract vehicle provides us an opportunity to share how to improve the performance of federal services using a customer experience as a primary driver for change. The FAA’s mission focus on maintaining the world’s safest and most efficient aerospace system makes it an excellent candidate for design-thinking and a customer-driven approach.”

We are also a part of the following federal government contracting vehicles:

Government-wide

  • GSA Professional Services Schedule (PSS)
  • GSA Performance Management / Continuous Process Improvement Blanket Purchase Agreement (PM/CPI BPA)
  • Service Disabled Veteran-Owned Business (SDVOSB) set-aside
  • Army Research Lab Advanced Expeditionary Warfare Development (AEWD)

Department of Veterans Affairs

  • VA Agile Delivery of VA Imminent Strategic and Operational Requirements (ADVISOR)
  • VA Veterans Enterprise Contracting for Transformation and Operational Readiness (VECTOR)

Department of Defense & Department of Homeland Security

  • Washington Headquarters Service / Acquisition Directorate (WHS/AD) Logistics Services (LOGS) Blanket Purchase Agreement
  • Navy SeaPort-e
  • DHS Program Management and Technical Services (PACTS) II

 

See our contracting vehicles page for more information on each.

News Release: Technical Assent Welcomes Todd Sadowski as Director of Business Development

NEWS RELEASE

Technical Assent Welcomes Todd Sadowski as Director of Business Development
The new role for the company follows a banner year in growth

Todd Sadowski

ARLINGTON, Va., November 29, 2018—Technical Assent, a leader in federal government customer experience, has hired industry veteran Todd Sadowski as the company’s first director of business development.

Todd is a client relationship executive who has supported several Service-Disabled Veteran-Owned Small Business (SDVOSB) companies during their highest growth periods. He will leverage this experience and his relationships with leading government partners to fuel sustainable growth and build new business opportunities at Technical Assent.

“We see government leaders increasingly recognizing the benefits of using customer experience to improve their program performance,” said John DiLuna, Technical Assent’s founder and CEO. “It sounds simple—design government services that people prefer to use—but there are several key factors that program managers need to get right to set the effort for success.”

The new role of business development director at Technical Assent addresses this need.

“As a member of the executive leadership team, Todd will be helping prospective clients target the correct mission problem and making sure Technical Assent and our partners are in the best position to solve it,” said DiLuna.

About Technical Assent

Technical Assent is a consultancy to the federal government that improves agencies from the bottom up—starting with customer experience. Technical Assent helps agencies design, implement, and deliver services that inspire by providing customer-experience design, solution implementation, and services management.

The company is a SDVOSB and prime contractor on the Department of Veterans Affairs flagship VECTOR contract in addition to other government-wide contract vehicles such as the GSA Professional Services Schedule. As a CMMI-SVC/3 firm, Technical Assent is committed to providing exceptional service experiences and delivering consistent results to its federal government clients.

For more information about Technical Assent, visit www.technicalassent.com and www.linkedin.com/company/technical-assent.

Media Contact

Chris Bobbitt
cbobbitt@technicalassent.com
202-904-8527

Video: Design Thinking Explained

Sometimes helping kids with homework takes a little out-of-the-box thinking! Design thinking, that is.

In this video, I help my son, Vinny, build a boat for his kindergarten water day by applying the principles of design thinking. It was a fun project for both of us and a great way to illustrate the basics of design thinking.

More articles from Technical Assent about design thinking:

In Government Service Design, Thinking Like Your Customer Is Not Enough

Avoiding the Sugar Crash of IT Modernization

Making Virtual Design-Thinking Efforts Effective in Government

Epic Presentation-Fail Yields Real-World Prototyping Lessons for Government