Scaling Patient-Centered Senior Care by Centering Values

Community Aging in Place – Advancing Better Living for Elders (CAPABLE) program at Johns Hopkins School of Nursing, Baltimore, Maryland, 2018

CAPABLE is a patient-centered home health care program that equips seniors to age on their own terms by addressing both the client’s home environment and the client’s self-determined goals. The four month program matches low income seniors with a three person home health care team comprised of a Registered Nurse (RN), an Occupational Therapist (OT), and a handy person. The team receives intensive training in how to deliver client-centered care. 

user testing a prototype

PURPOSE

The CAPABLE team approached the Center for Social Design during a pivotal moment in their organizational growth. They had demonstrated the impact of their model through a Randomized Control Trial and were ready to scale, but they sought guidance in how to maintain their patient-centered values–the source of their impact–as they scaled.

In the research phase, our design team learned that people often misunderstand what CAPABLE is when they first hear about it. Many people mistake CAPABLE for a program that installs grab bars, totally missing the heart of CAPABLE’s client-led approach. As a result, CAPABLE had experienced difficulty in communicating with prospective clients and potential implementing partners. In one geographic area, a CAPABLE program had struggled to recruit clients because there was another program in the area that had already installed grab bars in many peoples’ homes, and families tended to confuse CAPABLE with the grab bar program. In other instances, health care organizations believed that they were already implementing the CAPABLE model when in reality they were missing the most essential elements of it. On the other hand, the CAPABLE team had found in their research that programs do not need to reproduce the CAPABLE model exactly in order to achieve results, and implementers emphasized the importance of adapting the model to local contexts. As a result, there was a need to establish with much more clarity what CAPABLE is all about, without turning the model into a prescriptive recipe that would prevent local chapters from making the program their own.


PROCESS

Frame & Plan

  • Through semi-structured interviews and relationship-building conversations with the CAPABLE team, our design team framed our research into two main buckets, which we dubbed “Scaling with Values” and “Training for Transformation.”
  • I chose to focus my design work on Scaling with Values.

Research

  • We created an interview guide and conducted semi-structured interviews with experienced and newly trained RNs, OTs, and handy persons.
  • We also used activity-based visual interviewing techniques.
  • I researched the scaling techniques of the Movement for Black Lives as analogous inspiration.

Synthesize 

  • We synthesized key themes and insights from our research using Mural.
  • I visualized key findings by creating a journey map of an RN’s process of joining CAPABLE and eventually becoming a veteran of the program.
analog version of the journey map I created to invite interaction and feedback

Ideate

  • We facilitated the CAPABLE team through an in-person, collaborative ideation process.

Prototype

  • I created a series of low fidelity prototypes based on the top ideas voted on by the CAPABLE team.
  • We hosted an in-person prototype testing feedback session with the CAPABLE team.

Implement & Iterate

  • I incorporated the CAPABLE team’s feedback on the initial prototypes I built by creating additional prototype iterations.
  • I created an action plan for how the CAPABLE team could implement the prototypes.

OUTCOME

One of the top ideas to come out of the ideation session with the CAPABLE team was to contextualize the CAPABLE program within a larger movement for aging with meaning. I created two prototypes for this idea, largely inspire by the analogous research I did on the Movement for Black Lives.

Iconography for a Movement for Aging with Meaning

prototypes of movement values iconography, with increasing fidelity

This prototype is for iconography to represent the four essential values or guiding principles of a movement for aging with meaning. These values encompass the values that CAPABLE had already identified and are a distillation of key trends from our research. I tried to describe each value without jargon and from a human rights-based perspective which includes all people (we will all age, after all), rather than from the perspective of clinicians discussing their aging clients.

three dimensional prototype of movement values iconography, designed to show the versatility of the icons

The purpose of this prototype is to help CAPABLE clinicians feel like they are part of a greater movement, as well as encourage other institutions that serve people who are aging to adopt movement values. These prototypes are also designed to help clearly communicate the essence of CAPABLE’s approach.

Website for a Movement for Aging with Meaning

I created this analog wireframe for approachable user testing, and then I digitized the wireframe after iterating it based on user feedback.

This prototype is for a website that:

  1. Describes what a movement for aging with meaning is
  2. Invites practitioners to participate in a movement for aging with meaning
  3. Offers resources to practitioners who are working to integrate the values of aging with meaning into their work.

The prototyped Aging with Meaning website functions in addition to the already existing CAPABLE website by convening organizations that are aligned with the aging with meaning values and sharing generalizable content across those organizations. The audience for the website is narrow: current and future clinicians and other types of practitioners offering healthcare and other services to people who are aging. 

The prototype I created included:

  1. A description of the 3 primary purposes of the movement website and 3 example personas of movement website users
  2. A wireframe of the overall structure of the website as well as detailed drawings of key webpages

In addition to the prototypes I created, I also prepared a recommended plan for implementation for the CAPABLE team.

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