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Human-Centered Design
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Healthcare Projects
The COVID Vaccine Equity Project
Context:
With support from the United Way and St. David’s Foundation, Community Resilience Trust (CRT) joined a collaborative of organizations serving five Central Texas counties: Travis, Hays, Bastrop, Williamson, and Caldwell. These emerging collaborations, including the 5-County Collaborative funded by United Way, were created to bring about a comprehensive approach to vaccine equity.
Within this scope, CRT had been regularly analyzing and reporting on the state of vaccines in Central Texas, as well as the trends, strategies, and opportunities for addressing gaps in the equitable distribution of COVID vaccines throughout the region since May of 2021. The following is the culmination of best practice workshops for future equitable vaccine distribution rollouts.
My Role: Design Lead [CRT]
Research Goals:
In order to ensure the equitable barriers to equitable vaccine distribution, we must have a real-time understanding of how we as a community are doing in any given moment and have as much information possible to determine who is being left out, how they are being left out, where they are, and how best to reach them.
Our Research Goals were divided as follows:
Facilitating alignment on collaborative priorities, best practices, and steps to take for improving the equitable distribution of vaccines in the future.
Understanding the various stakeholder perspectives (institutional and lived) who were involved with informing and shaping the vaccine distribution ecosystem.
Mapping out the current intersecting players and institutions (including their barriers, capacities and limitations) that comprise the vaccine distribution ecosystem.
Creating the roadmap that allows for a responsive, inclusive, and streamlined approach of achieving equitable care within the Central Texas vaccine distribution ecosystem, after taking into account the above considerations.
Research Questions:
How Might We...Create a More Equitable, Systemic Approach to Vaccine Distribution for Future Pandemics within the Central Texas Region?
Framework Used:
Human-Centered Design [IDEO and IxDF mixed-methods]
Disclaimer: It is the position of CRT that the role of any public health initiative is not to convince anyone to vaccinate, but rather to provide culturally and situationally relevant information and an inclusive and accessible opportunity to participate from the very beginning. As such, the focus of this work is evaluating the degree to which access to vaccines (and comprehensive, culturally and situationally relevant information about vaccines) are available to everyone, regardless of race, age, socio-cultural orientation or socio-economic status.
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Design Process
Understanding Human-Centered Design
Research Methods:
Mixed Methods: Attitudinal & Behavioral [behavioral during the self-selection workshops]; qualitative and quantitative approaches using survey distribution, contextual inquiries, focus-group/workshop analysis, interviews, field observation, journey mapping, process mapping, systems mapping.
Tools Used:
Miro; Google Apps such as: Google Forms, Google Sheets, Google Docs, & Jamboard; Microsoft Excel, PowerPoint; DSHS Vaccine Data...
Inclusion Strategies:
In effort to model our collaborative work and make as inclusive as possible, each workshop was designed by the Community Resilience Trust with inclusion strategies, which ranged from having ASL interpreters for the deaf community, Spanish language interpreters for our bilingual community, captions, and meeting agendas, as well as translated meeting invites, surveys, and notes, in order to build trust within groups historically underrepresented in our society.
Other inclusion strategies we used were:
Calling people to invite.
Providing compensation incentives for time, if requested, by CashApp, PayPal, or Check by mail.
Considering clusters of perspectives that need to be represented and consider how many of each should be represented + organize targeted outreach accordingly.
Including members from the unhoused community, with compensation to attend.
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Human-Centered Design
An Inclusive Approach to Systems & Service Design
Human-Centered Design (HCD) is based on empathy and problem ambiguity, as opposed to preconceived assumptions of knowing what the problem[s] actually is/are. Through this process, we strive to keep vulnerable and affected communities at the center of our work and we attempt to solution for underlying root systemic causes, while not ignoring the symptoms of such root causes as they manifest. The most important component of Human-Centered Design is involving the actual people impacted by faulty systems or services needing redesign and always considering their feedback and viewpoints when iterating and testing.
As Human-Centered Designers, we aim to find the “right problem,” by conducting interviews, and desiring to deeply comprehend the experiences of the communities who face access problems-- be it in housing, food, education, etc., and in this case, vaccine healthcare, on a daily basis. If we do not involve them in our process and iterate solutions based on their input and feedback, we cannot assume our solutions are for their benefit and welfare.
Research Phase
Research to Inform, Inspire, & Ideate
Workshop Series Background:
As part of our Research Process, we conducted a workshop series aimed at a Participatory Design Discovery analysis. Our main goals included: (1) Stakeholder Alignment, (2) Current Systems-State Mapping, and (3) Process Redesign and Prototyping.
Note: While this project was less heavy on implementation and testing, as is typical for a Human-Centered Design Project, it was CRT’s approach to involve all members of the vaccine distribution ecosystem and document their experiences in order to create an equitable distribution to the COVID-19 vaccine for our more marginalized and underrepresented groups.
Systems Mapping Prototype:
Using our background of CRT having participated in regular data zip-code level data collection of the vaccines since May 2021, we proceeded to draft a rough systems sketch of how we knew the COVID vaccine distribution process in Central Texas. See the map below. We would later create a high-fidelity prototype via Miro, for Workshop purposes with our invited Participants.
Tool Used: Jamboard
Data Alignment & Survey Distribution:
Our Data Alignment Workshop was for Participants who were heavy on data tracking during the COVID-19 Pandemic. Subsequent surveys were distributed among all our participants and later documented in an internal database, including a Stakeholder Registry.
Data Toolsets Used:
DSHS, APH Zip Code Level data and Organizational event data were the most common data toolsets used.
Analysis:
Coming into our working sessions, we identified seven main stakeholder groups:
Community Organizers
Community Members
Vaccine Providers
Healthcare Providers
Research/Data Analysts
Funders
Policy Makers
However, upon self-selection of our participants into each of their respective breakout rooms, it became clear that some of our groups needed to be combined and some of our members considered themselves members of another group.
Over the Workshop Series, “Funders” and “Policy Makers” were noted as choosing to self-select in other breakout rooms/groups.
We later learned from feedback that this was because many of those categorized individual “stakeholder types” did not see themselves as authoritative final decision makers within their organizations, regardless of if they were staff within a policy/ funder organization.
Therefore, the subsequent breakout rooms sessions were reorganized into the following three main groupings, eliminating the “Funders” category all-together:
Healthcare and Vaccine Providers [Policy Maker's perspective included*]
Community Organizations + Community Members
Research/Data Analysts
Initial Mockup
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Stakeholder Assessment
Research Phase
Objectives:
Identifying key players and strategic roles involved in the vaccine collaborative efforts
Begin to generalize the perspective of each stakeholder group, including their roles, responsibilities, experiences, constraints, goals, barriers, intentions, funding sources, and available action sets. (By action set, we mean the limited scope of actions currently available inside of any particular view/position.)
Analysis:
Identifying Strengths, Barriers, Frustrations, Strategies, Wants, and Goals via Google Jamboard yielded the results below per group.
These results were later extracted and placed on a Miro board to prioritize in our final Design Session among our consolidated Participant groups.
Systems Design Workshop
Planning Phases
Step 1: Creating the Registry
The overall goal of this Stakeholder Registry was to formulate an in-depth analysis of our Stakeholders [i.e. Participants]. We aimed to create a mutual understanding and shared high-level view of the various stakeholder perspectives (institutional and lived) informing and shaping the vaccine distribution ecosystem.
Tools Used: Google Sheets
Step 2: Hammering Down the Systems Map
After CRT's initial mockup (shown above), we began to solicit feedback from our system and Workshop Participants to validate our understanding of the vaccine delivery process. This was considered research during finalizing our Resource Maps, (shown below).
Step 3: Ranking Needs
After gathering feedback from our Workshop Participants, we proceeded to invite them to rank their collective responses (displayed above), in terms of highest priority/barrier to least.
Step 4: Collective Alignment
Collective Alignment through Journey Mapping was our next step to completing an accurate Service Delivery Model.
Step 5: Future State Planning
Our Future State Plan of Action!
Initial Mockups for Participant Feedback
Resource Mapping
The following resource flows were created for feedback purposes during the Third Workshop. Participants were placed into specific breakout rooms at random, where they were given a time period in which to identify [via coded sticky notes] where barriers, challenges, bottlenecks, opportunities and pain points were most likely to occur within the flow. Each sticky note was color coded according to our stakeholder type.
Approvals
Structures in place for institutional and organizational approval processes were often cumbersome and long, which effected funding and was based on aggregated data.
Final Map
Copyright by CRT 2022
Next Steps
Dashboard Buildout & Collective Strategies for Calls-to-Action
Iterative Use of Data
The most important of all recommendations was to have a shared data set owned by the public health office and emergency management, working alongside community organizations. This would serve as the carrot on the stick in hyper locating funding sources for the most vaccine hesitant communities. Addressing vaccine distribution at the zip code level, should also include the demographics and geographic data necessary to provide iterative strategies for future rollouts.
Other recommendations include:
Operationalizing a combination of real-time investigatory and intersectional data analysis, diverse community engagement on strategy development, and departmental support throughout the 5-county vaccine ecosystem.
Funding the Ecosystem
Fund community partnerships early.
Fund the entire network of community organizations, prioritizing diverse representation.
Reduce barriers to funding, especially for organizations whose work in the community is unparalleled and serves a specific target population not served by other organizations.
Find them and fund them. Working backwards from FEMA’s list of at-risk communities, find the local organizations that serve these communities, especially those led by people that share the lived experience of the population served.
Provide capacity building supports for smaller/newer/scrappier organizations.
Provide or facilitate access to expensive resources such as: free event space, free printing, and free interpretation services for community-led pop-up events.
Consistently Spreading Relevant & Actionable Communications
Essentially this calls for reducing siloes in our Central Texas community. Particularly in the following ways:
Reduce silos in government to allow easier access to testing kits and vaccines.
Create collaborative spaces.
Develop inter-organizational logistics that reallocate resources laterally to redistribute them more equitably.
Having culturally appropriate material in a variety of languages.
Prioritizing Situational and Geographic Access
Create “access first” approaches. Meet people where they are. Make it easier and convenient. (While hesitancy may be relevant, assuming hesitancy obscures barriers to access.)
Track, evaluate and iterate on the efficacy of place-based solutions.
Print materials, confirmation emails, web pages and infographics should be translated into Spanish and common immigrant languages, and where appropriate, include accommodations for deaf and blind community members.