Part 1: The Ask
This is the tale of two healthcare systems.
The first system, which we’ll call System Green, styled itself as an innovator but was struggling with high turnover among frontline staff, the first point of contact for patients entering their facility. While some employees had been in the position for several years, it was more common for them to leave the role after just six months.
The second system, which we’ll call System Red, prided itself on its efficiency. They also had a frontline position, but their focus was on better training these employees to more quickly and accurately process patients and visitors as they entered and navigated the facility.
As the healthcare industry continued to struggle with burnout and shortages in the wake of the COVID pandemic, my organization was contracted by both of these systems to develop training programs that would realign entry-level staff with their roles. As designers, our team couldn’t help but note the unique opportunity that had presented itself to us; namely, to engage in real-world, side-by-side comparative testing at a unique moment in history. We wondered: what could be learned from these two systems—about partnership, cooperative co-design, and the implementation of solutions?
Here is what we found.
Part 2: The Research
After all the planning, scoping, and negotiating, it's finally time to kick things off! Research can feel slow to get started—so slow that it might lead clients to wonder whether it’s even worth it—but it’s fundamental to our work and a necessary insurance against the pitfall of thinking we’ve got it all figured out.
Initially, both projects began in a similar fashion. System Green, the “innovators,” came to the table buzzing with excitement and handed over a list of technology solutions that they thought might improve employee performance and patient experience. System Red had recently implemented one such solution—costly training supported by bleeding-edge VR tech that was meant to give employees a deeper connection to their roles and standards of service—and wanted us to continue building on the foundation they had already developed.
Human-centered design is a notoriously ambiguous process. In the beginning, it’s best to focus on the root of an organization’s challenge, avoiding preconceived “solutions” and waiting until later to make any conclusions about how it ought to be tackled. This requires that the designer know the organization inside and out—in some sense, given the unique perspective of the outsider, even better than they know themselves. Accordingly, our first step was to get our hands messy and learn everything we could about the reality of the employee and patient experiences at both systems.
This is where our two systems begin to diverge from one another. System Green, clearly benefiting from functional and effective leadership, adapted easily to the research process, inviting feedback from a variety of perspectives and keeping an open mind about possible solutions. System Red, on the other hand, seemed to suffer from an uncertain hierarchy, with decisions being made by a fractious and indecisive panel of individual actors, each with their own professional stakes and personal agendas.
According to NTT data, 78% of executives say that innovation efforts are held back by poor organizational culture. One sign of such a culture is a marked distance between primary decision-makers and the lived reality of the organization they lead. Healthcare is, at bottom, what’s known as a “people business,” and strong relationships are key. When leaders make choices based on written reports or data, rather than first-hand observation, they run the risk of implementing solutions that purport to solve problems that don’t actually exist, or exist in a way that renders the solution ineffective. This misalignment leaves workers feeling misunderstood or undervalued—a feeling of dissatisfaction that is easily perceived by the patients and consumers with whom they interact.
As outside designers, it's our job to uncover ideas that align an organization’s vision with its needs, but those ideas can only be successful if they’re met with a culture of curiosity and learning that’s willing to accept them. System Red, on the other hand, operated according to a culture of division and competition in which what might otherwise have been considered an insight was instead construed as an attack. Great designers are also skilled diplomats with plenty of experience dealing with “difficult” clients—but, at the end of the day, our work is only as effective as it’s allowed to be.
Part 3: The Findings
For a new idea to take hold, the old one must stand aside to make room. This is the moment where naysayers and the costs of upfront investment might have clients second-guessing our findings. But moving from problem to idea to practical solution means implementing real changes, which is only possible given an eager and willing leadership with guts and faith.
It didn’t take long for us to discover that the reason for the high turnover among System Green’s frontline population was that these entry-level, supposedly “unskilled” employees were being poached by other departments due to their first-hand knowledge of the facility, which is notoriously complicated, and its patient population, which is often extremely ill. This wasn’t something that leadership wanted to discourage per se, but they did recognize the need to hold on to knowledge of seasoned employees.
With System Red, my team was told to expect a frontline population of fresh-faced, inexperienced workers; what we found instead was a mix of long-standing staff—who were waiting for retirement—and entry-level employees—who wanted to get a foot in the door but quickly learned that nearby facilities provided more opportunity than their current position. In spite of leadership’s spectacular, single-day VR training experience (or perhaps because of it), employees still struggled to understand their role or feel a connection to the organization.
Contemporary technological advancement has presented us with an array of shiny solutions that we’ve come to associate with “innovation” but that fail to deliver on their promise. This is often due to employee resistance and an organizational culture that won’t accommodate any real change beyond the superficial. System Red’s flashy VR boondoggle, which impressed new hires but did little to build knowledge or purpose for seasoned employees, was clearly the product of a leadership team that wasn’t able or willing to seriously consider how the effort might be received by staff. Like countless
“innovation” efforts implemented from the top-down, it was thus doomed to failure from the start.
Part 4: Implementing Solutions for Success:
The research is done and key insights have been uncovered. Now what? In order to successfully implement solutions for success, leadership must approach innovation as a culture to be cultivated and practiced—not a box to be checked.
It seemed that the best way for System Green to respond to the moment was to shift department goals towards better addressing patient needs. To accomplish this, we recommended that certain members of frontline staff be elevated to a new “lead” role from which they could conduct a freshly designed peer-to-peer training program. The idea was to build a system for transferring knowledge between seasoned and less-experienced employees that would stem turnover and act as a scaffolding for future innovation efforts. Training materials were co-designed with our partnered leadership in System Green, along with their training and onboarding departments, and then reviewed for feedback by the employees who would be implementing them.
While it was evident that System Red would have benefitted from a similar training program, leadership doubted from the outset that these entry-level, “unskilled” workers would be capable of carrying it out. After we made a concerted effort to persuade them otherwise, they allowed us to construct a peer-to-peer training program—but not to re-engage with frontline workers for feedback and fine-tuning. Instead, all feedback was received through executive decision-makers, most or all of whom knew far less about frontline employee experience than the employees themselves. Ultimately, in spite of a stated desire to empower the employee population, the perceived need for oversight prevailed.
Investment can be a hard sell when it comes to entry-level high-turnover populations. Because these jobs are frequently labeled “unskilled” and require minimal experience for entry, they tend to experience high turnover and low rates of employee satisfaction, and the healthcare industry is riddled with them. There is a common, sometimes unspoken narrative that one can expect only so much from these positions, and that precise rules and regulations are necessary to keep these types of employees on task.
There is a sort of self-fulfilling prophecy at work here: because employers pay entry-level workers less than what they’re worth, they underestimate their value and commitment; because they perceive these workers as being low in value and commitment, they continue to pay them less than what they’re worth. Naturally, this translates to a decline in the quality of patient experience: when we ask those who make the least to overcome the most, all while juggling patients without support, we should expect our consumer experience to suffer. There is clearly an important conversation to be had around wages—but if we can’t start with the dollar, we can at least begin by building a more sustainable system that invests in its employees for the long run. This requires leaders who model and encourage curiosity, shaping an environment where staff feel empowered to ask questions, share ideas and continuously improve.
Peer-to-peer coaching is an excellent means of constructing this sort of organizational culture. Studies show that employees who regularly engage in peer coaching are 65% more likely to feel fulfilled at work, 67% more likely to report being a top performer, and 73% more likely to report feeling a sense of belonging at work. But all of this is only possible if everyone involved sincerely believes that even entry-level workers can be cultivated and encouraged as leaders among their own ranks. As Les Brown said, "Nobody rises to low expectations."
Part 5: The Outcome
The moment of truth: will the investment achieve its goal? Or will the organization, unready for change, cut its losses and move on?
System Green, convinced of the importance of a long-term investment in their employee population, plans to continue running the six-month, peer-to-peer program twice a year as ongoing training for frontline employees. Initial feedback has been promising, with trainees specifically noting that they felt encouraged to think beyond go-to patient responses and were excited to have a formalized system they could share with their fellow teammates. As one such worker noted, “it really puts me in the mindset of the patient, which means that I end up thinking more about what I say.”
We can easily identify the leadership choices that allowed System Green to embrace a successful design outcome:
- Pause and Pivot: While leadership already had preconceived solutions at the beginning of the design process, they remained open to pausing and pivoting to respond to the needs of patients and entry-level employees.
- Invest in Innovation: Decision-makers approached a high-turnover population as worthy of investment—while also addressing challenges sustaining patient experiences.
- Champion Solutions: Organizational leaders were willing to listen and respond to input while championing their solution when faced with implementation challenges across the organization. Working as partners with our design team, they were able to marshall their resources and push the project past the finish line, insisting that old ways of thinking be reevaluated in favor of fresh, new ideas.
System Red successfully completed a pilot of their peer-to-peer training program to positive feedback from employees, who felt more connected with one another and expressed appreciation for the extra time available for group brainstorming. In spite of this, they have no plans to continue the program in the future.
What went wrong for System Red? As with System Green, the final outcome of the design process was due in part to choices from organizational leaders:
- Plow Through: Efforts to improve organizational performance became more about change in appearance rather than reality. Accordingly, leadership concerns remained superficial in nature, and the project quickly devolved into a mess of inter-office politics.
- Trust Tech Over Workers: Investments in costly, tech-forward innovation solutions failed to produce the expected outcome. Rather than consider that this might be due to the ineffectiveness of the solution, management assumed that the employees themselves were likely to blame. Accordingly, confidence between leadership and employees continued to diminish.
- Fizzle Out: Much like System Red, 58% of workers rate their organization culture as "weak" or "mixed" as it related to fostering innovation, leading to a failure to thrive. Accordingly, projects that may have bubbled with excitement at the start quickly fizzled out in the absence of widespread support.
Before you start your next project, ask what system are you prepared to be?
