How human-centered design can help VA prioritize people over processes.

E 3Chris returned to the room with his beloved trumpet case. He gently picked it up, raised it to his lips, and began playing. Just 30 minutes earlier, I was afraid that if we asked the wrong question he would crumble — his eyes said everything. But here we are, standing in the social room of a transitional housing facility in Los Angeles, listening to this formerly homeless Veteran playing the music that brought him solace, and maybe even some joy.

This was our first day of 12 on the road — our second conversation of approximately 100.

In support of Secretary Bob McDonald’s efforts to create a Veteran-centered VA, our team of six traveled across the country for 12 consecutive days with one single goal: to better understand the Veterans we serve.

You see, our small team works for the VA Center for Innovation (VACI). Since our inception as a pilot initiative of the Office of the Secretary in 2010, we have grown in not only size and identity, but also in our approach to innovation. As we work to support the growth of a 21st century VA, it has become increasingly clear that if we are serious about innovation — before effective, sustainable change can occur — we must first understand the people we serve.

This is why we decided that it’s time to get outside of the building and meet Veterans like Chris, each with their own story to tell.

“A desk is a dangerous place from which to view the world.” – John le Carre

In pursuit of this deeper understanding, in the spring of 2014, VACI piloted a design-thinking methodology that has proved tried and true outside of government: Human-Centered Design (HCD). The pilot (focused exclusively on the “discovery phase” of the methodology) yielded valuable insights, an initial look at user personas, and a clear picture of the customer journey. Yet one of the most important outcomes of the pilot was a confirmation that the HCD methodology (1) is valuable and implementable within the VA context, and (2) is critical to our understanding of our customers.

This past fall we scaled up our HCD efforts to validate and build upon the personas and user insights from the spring pilot. We spoke with over 100 Veterans across the country — an experience that has left us with two wholehearted beliefs about the power of this work.

E11. Nothing can replace face-to-face conversations. We spent countless hours speaking with people. We listened, shared stories, cried, laughed, and in the end felt a real connection when we parted ways. It is this kind of understanding that should form the core of our work as public servants— whether we are building a website, or greeting a Veteran as they check-in for an appointment.

2. HCD both demands and creates empathy. Speaking to customers through the HCD process demands empathy. It forces you to check your assumptions at the door, focus, and listen to people — really listen. And the more people you speak with, connect with, and understand, the more empathy you gain. We need more of this, not only at the VA, but throughout government. Providing great service requires understanding those we serve, and understanding those we serve requires empathy.

The “human” part of Human-Centered Design is key. It ensures that our work — the services we provide, the technology we use, the products we build — are centered on a deep and personal understanding of the people we are designing for. After all, it is that humanness of our work that drew us to public service and it that same humanness that should drive us every day.

E2“We are dealing with people, not procedureswith Veterans issues, not our own.”

These wise words were spoken in 1947 by VA Administrator General Omar Bradley. Yes, you read that right: 1947. Yet they ring just as true today.

We believe HCD can help is reorient our operations around the needs of the people we serve – Veterans and their families – and are committed to expanding HCD efforts in the months and years to come.

During our HCD pilto we asked Veterans what, if any, company/organization really understood them. Who, if anyone, provided them with A+ service? Overwhelmingly the answer was: “USAA.” Ten years from now, we  hope that the answer will be “VA.”

Evagelia Emily Tavoulareas is a civic technologist working to make government more effective, efficient and people-centered. She currently leads engagement at the VA Center for Innovation, where she is focused on digital services, open data and design-thinking.

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Published on Nov. 18, 2014

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  1. Danny December 4, 2014 at 1:37 pm

    how ironic! Just about a week after our president announces his new immigration reform the Department of Homeland Security hires 1000 new employees to care for illegal immigrants, yet the VETERANS Administration can’t hire enough people to take care of those of us that have served this great country. Secretary McDonald can’t do it by himself; our (?) government is spending too much money taking care of other important matters; many of which the American public feels they should not even be involved in. This government is so out of touch!

  2. James Kahn November 21, 2014 at 10:08 am

    The VA may wish to move toward being patient/Veteran Centric but there will be no progress toward that goal as long as the primary labor force in health care is still afraid or reluctant to do so.
    The nursing body has been oppressed for so long that it is collectively afraid to act in the best interest of patients. One of the primary expectations upon which the field of nursing was built upon is patient advocacy but in the VA nurses are conditioned to not care at the risk of their employment.
    I am a great example as a casualty of this culture.
    I am a disabled Veteran, I am a medically retired nurse corps officer, and I am one who has been deployed to the paperwork combat zone that is VA benefits since my medical retirement in 2011. In short I have a heart for the Veterans that came to me for help when no one else would do anything but refer them on to some useless phone number or person who would simply refer them to someone else. I was a, “buck stops here,” patient champion that would help Veterans find solutions rather than simply new mazes to navigate.
    The reward for my efforts was termination by the VA and threats to further ruin my nursing career by making false reports to the Nurse Licensure Board in my state.
    Nursing within the VA is grossly oppressed and as a result change will be difficult if not impossible due to good nurses being muted in their ability to affect change or worse terminated without cause when they do try to help Veterans and it illustrates how poor the system is working.
    The answer in the short term is as the Secretary has proposed, give Veterans the option to take their business to people that actually are driven by performance improvement and customer service expectations, Non-VA providers.
    It really is a statement of non-faith when the best answer we have for how to remedy the challenges within the system is to take the customer out of the system.
    I have many observations that would be valuable to anyone at the VA that would care to listen, my email is attached to this message, please feel free to contact me, after 18 months fighting for Veterans on the inside I could help the Secretary at least get honest answers where the question as to what is going so poorly internally is concerned.
    To the Veterans that I had the honor of taking care of while I was still employed at the VA take care and may God bless.

  3. Danny November 20, 2014 at 5:12 pm

    judging by the very dramatic decrease in comments on this blog website, I get the feeling that runs are getting tired of words only. Many actions are being taken, however we the veterans are not really seeing the results of those actions. My brothers and sisters, please don’t lose interest in what the Veterans Administration is trying to do for us! If we show them that we are losing interest, why should day have any more interested in us? Please don’t forget, WE ARE THE VETERANS IN THE VETERANS Administration!

  4. Clara C. Martin November 20, 2014 at 2:40 pm

    I’ve been dealing with the Washington, DC VAMC since 2011. My first day there was in February, 2011 when I was seeking eligibility information, and prescription assistance. The atrium appeared to be in chaos, however, on subsequent appointment visits the noise and chaotic behavior was also present.

    I was medically injured from negligence by VA staff and ended up in a private hospital in Fairfax County, Virginia. This was in 2012. I was also injured in January, 2014 and, once again, couldn’t get service at the Washington, DC VAMC for operations on my injured knees. Since September, I’ve re-submitted the out-of-pocket bills that the VA said it would pay after telling me to go to the emergency room in 2012, and after my primary VA doctor put in a referral for me to go to the non-VA orthopedic surgeon in 2014, respectively, As of today, November 20th I haven’t heard a word from anyone at the VA and no phone calls are being returned.
    Secretary McDonald, you have your work cut out for you Sir. Best Wishes!

    Clara C. Martin
    Former Capt. Signal Corps

  5. James Lanier November 20, 2014 at 1:34 pm

    I don’t understand why with all of Veterans being pushed out of the service by the present administration they can’t increases the number of doctors and clinics to treat them and the ones that got out before them. I have have had 3 back surgeries because of an injury I received while in the military plus several other problems that were declined by the VA.
    I was fortune to have private insurance at the time of the surgeries. I no longer have private insurance because of Obama Care. So I have to rely on the VA for my care if I can get an appointment!

  6. Danny November 20, 2014 at 11:49 am

    It is time to remind the administration. ….
    Instead of abbreviating (VA) I will try to start spelling it out every time. Maybe they will get the message!!?? Secretary McDonald has heard us, now the other employees need to HEAR US!

  7. Catherine M Gillis November 19, 2014 at 12:43 pm

    I am delighted to see that the Veteran’s Administration is taking a human-centered design approach to creating products and services for Vets. I’m employed by Azul 7, a human-centered design firm. One of our principals is a veteran, and passionate about making better experiences for veterans. We know from our extensive work in health and wellness, that when we use human centered design principles, we solve problems better, make stronger connections and improve people’s lives.

    Thank you for undertaking this most important and urgent work

  8. eugene gabrielli November 19, 2014 at 12:42 pm

    It is about time somebody is doing something to make the va a much better organization to work with.I’m thankful for Mr McDonalds efforts to streamline the va. he needs to also concentrate on the process of claims compensation for veterans. It has been nine years since my claim for compensation, now I in the appeal process for one year and probably one or two more years before I get a hearing this is way too long for any of our brothers and sisters to have to wait in pain. I am not getting any better and I will probably die before any compensation is granted. A lot of veterans that I have spoken with feel the same way. Promote or hire more people to help expedite the process more quickly. Is this too much to ask for? How many veterans have died without compensation? Get a clue and do something about this horrible problem before more of our veterans cannot feel appreciative for serving their country.

  9. Derek J. Johnson November 19, 2014 at 10:38 am

    This is precisely the kind of work that I would relish doing! Reaching out to my brothers and sisters in arms across the generational divide of peace and war time theaters and connecting veterans to resources. What a sense of value and purpose in being able to help people, especially those that I feel a kindred spirit with in having served with them. I commend the VA for facing a daunting task head on and being proactive. Errors have been made, yes. Steps are being taken to learn and grow from those errors. I believe in the VA, and feel in my heart that this ship can be righted, re-fitted and re-launched as a flagship for others to follow.

    Respectfully submitted,

    Derek J. Johnson
    USAF 1987-1992 (Honorably/medically discharged)

  10. Bryan Wilhelm November 19, 2014 at 8:15 am

    I too remain hopeful the Bob McDonald will prevail and turn-a-round the VA. I was truly blessed. After 4 years in the US Navy, I rose up through the ranks to become CEO. Success found me, but it all ended when my service injuries (toxic exposure and physical injuries) ended my career following a heat attack and stroke at 43. It was the beginning of my rapid decline. I am in my second year (NOD appeal filed) of probing the VA’s black hole of process for Disability Benefits.
    Bob and I are about the same age. We are the product of the same educational systems… during the same time. I see what he sees. I believe I know where he is going.
    I support Bob by sending weekly letters “Bene-Sugs” as beneficial suggestions, one veterans contribution. The letters are positive, focused and plausible methodologies based on proven techniques and improvement processes. May God bless the VA!

  11. Danny November 18, 2014 at 10:24 pm

    FINALLY! !all most of the veterans in the world today want is for someone to listen to them and treat them in the manner they have been promised they would be treated. As you travel and speak to the veterans, don’t stay at the Hilton, stay at the motel 6 or maybe the Best Western. If you really want to understand the veterans if you really want to empathize with the veterans understand that most of us in general cannot stay at the Hilton. Most of us are not homeless I am NOT I have a good 3 bedroom 2 bath home and a lovely suburbia environment. My brothers and sisters that are homeless like the young man playing the trumpet don’t want to see the key from the Hilton, they might even invite you to their home, which may if they’re lucky be a tent by the river.please don’t make it sound like all of us are downtrodden homeless and mentally incapable, I may have made that mistake and one of my comments, many of us are doing fairly well in spite of our invisible injuries as they are called. I wholeheartedly applaud the efforts of your team and most certainly the efforts of Secretary McDonald!

    • James P. Kahn November 20, 2014 at 6:10 pm

      The VA listens but does it hear?
      Veterans across the board are telling the same story, there are some pockets where caring individuals can be found, there are some pockets where non-caring individuals can be found, but the consistent message is a culture that performs in a substandard method.
      I am a recently former employee of the VA who was let go for taking care of people that other VA employees have failed repeatedly to take care of. Prior to my termination it was a common sight to see me calming down an upset Veteran and taking him or her to my office to figure out what was needed to help them to their satisfaction. I will not say that I was always successful, but what I will say is that I always tried to validate that persons concern and never left them hanging with no where further to look for help. On many occasions it would take multiple attempts at gaining purchase for a solution but we, the Veteran and I, made those attempts together and more than once were successful in overcoming the objective.
      Too many employees of the VA are uninterested or afraid to try where helping Veterans with their problems is concerned.
      I would be happy to further discuss the challenges the VA has where true patient centric care is involved.
      The VA has my email they are more than welcome to strike up a conversation, but if the past is any indicator they will simple ignore or delete this post as it is quite disconcerting for them to look in the mirror and find this Veteran staring back at them.
      Take care and may God bless us all.

  12. James Charron November 18, 2014 at 8:32 pm

    HCD, only in Pilot. You would have been better to JUMP-IN with both FEET. Some of US, VETERANS, DON’T HAVE TEN-YEARS TO WAIT..

    The VA doesn’t listen! The VA is grossly made up of GREED, Management, Employees, and some of these Employees, being Veterans too.

    The Veterans don’t care that you have a Mahogany Desk and a Plush Chair. Your desk could be a two-by-four on top of two barrels. The Veteran cares whether or not the VA is listening, to their issues. It is important, that some Veterans, are also Greedy, and only see the VA, as a BANK, for Financial Greed. This is the REALITY!!

    Glad to see the VA, is trying to turn around, but the VA will need to step up their process.

    Thank you.

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