Professional Documents
Culture Documents
Toward a Veteran-
Centered VA:
Piloting Tools of Human-Centered
Design for America’s Vets
Findings Report, July 2014
i
Toward a
Veteran-Centered VA
Piloting Tools of Human-Centered
Design for America’s Vets
Findings Report
July 2014
TABLE OF CONTENTS
The VA Center for Innovation (VACI) is a team of innovators and doers within the
VA who are dedicated to driving innovation at the largest civilian agency in the
United States Government. The team at VACI does not believe in innovation for its
own sake, but rather, in innovation that provides a tangible value to VA and to Vet- 1 EXECUTIVE SUMMARY
erans. The work of VACI is driven by a strong commitment to a Veteran-centered
approach to service delivery, a dedication to data-driven decision making, and a
commitment to design thinking. 2 What is Human-Centered Design?
Since 2011, VACI has worked to identify, test, and evaluate new approaches to
VA’s most pressing challenges. Balancing the practical with the aspirational, VACI
7 CHAPTER I
enables a steady influx of high value innovations into the VA, moving them from
A Pilot in Design Research at the VA
concept to operational implementation.
11 CHAPTER II
Meet VA’s Users
The pilot was a lead by one of VA’s 2013-14 Presidential Innovation Fellows.
21 CHAPTER III
The Presidential Innovation Fellows (PIF) program brings the principles, values, and practices
of the innovation economy into government through the most effective agents of change we know:
Research Findings: Veteran Experience of the VA
our people. The program pairs talented, diverse individuals from the innovation community with top
civil servants to tackle many of our Nation’s biggest challenges, and to achieve a profound and lasting 49 CHAPTER IV
social impact. These teams of government experts and private-sector doers are taking a “lean startup” Lessons from the Pilot:
approach and applying methods like user-centered design to achieve results for the American people
A Powerful Approach with Opportunity to Scale
in months, not years.
PROJECT TEAM
Mollie Ruskin, Presidential Innovation Fellow, Department of Veterans Affairs
Amber Schleuning, Deputy Director, VA Center for Innovation
Emily Tavoulareas, Portfolio Lead, Strategic Engagement, VA Center for Innovation
Melissa Chapman, Independent Researcher
Public Policy Lab, Special Project Advisor
THANK YOU
Kate Krontiris, Independent Researcher
Ben Willman, Presidential Innovation Fellow, Department of Veterans Affairs
Adam Dole, Presidential Innovation Fellow, Health and Human Services
Respondents of pilot participated willingly. Names have been changed to anonymize data.
EXECUTIVE SUMMARY
Toward a Veteran-Centered VA
Piloting Tools of Human-Centered Design for America’s Vets
context of the people for whom we design.” our user’s needs. These findings are further detailed
LUMA INSTITUTE ON
in Chapter 3.
HUMAN-CENTERED DESIGN
1 2
What is What HCD is...
Human-Centered
A PROCESS FOR DELIVERING
INNOVATION IN USER SATISFACTION.
Design?
Organizations both small and large DISCOVER + DEFINE
gravitate toward processes which Conduct user research and
prioritize business needs. This often synthesize findings to define
means that they design and build user needs and problem DISCOVER
statement. RESEARCH
products that reflect their own institu-
tional requirements and general SYNTHESIZE
DEFINITION: DESIGN + TEST
assumptions about users. Often prod- Potential solutions are gener- DEFINE
“An approach to systems design and development that
ucts and services aren’t shared with
“A human-centered aims to make interactive systems more usable by focusing
users for feedback until late in the
ated, ideas are translated into
prototypes and tested against
on the use of the system and applying human factors/
approach to innovation ergonomics and usability knowledge and techniques.”
process, or after launch. At this point, users, then refined to prepare
DESIGN
it becomes very difficult to accom- for implementation.
draws from the INTERNATIONAL STANDARDS ORGANIZATION 2
modate user feedback, and we find
IDEATE
DEVELOP + DELIVER PROTOTYPE
designer’s toolkit to WHY HCD:
that a great deal of time and resources
may have been put toward solving the
Architect and build new
TEST
services or products in agile
integrate the needs of “Rather than requiring users to adapt their attitudes and wrong problem entirely. increments, releasing new
behaviors in order to learn and use a system, a system can
people, the possibilities be designed to support its intended users’ existing beliefs, Human and user-centered design
user-facing changes in ways
to continue to refine based DELIVER
projects, on the other hand, are
of technology, and attitudes, and behaviors as they relate to the tasks that
the system is being designed to support. The result is a defined by a series of phases, in which
on user feedback and testing. REFINE
After launching a complete
the requirements for product that offers a more efficient, satisfying, and user- specific activities take place to continu-
ously understand and gauge the needs
service or product, continu-
BUILD
friendly experience for the user, which is likely to increase ously monitor and refine to IMPLEMENT
business success.” sales and customer loyalty. and reactions of users throughout: meet user satisfaction.
TIM BROWN, IDEO PRESIDENT & CEO1 USABILITYFIRST.COM3
3 4
What HCD is not...
A SINGLE SOLUTION. EXAMPLES OF HCD IN PRACTICE
Human-centered design does not It is by no means the only kind of Organizations like the VA histor- Capital One has created a new The United Kingdom has Kaiser Permanente has received
account for all factors involved with research we need to do to understand ically lean heavily on quantitative Capital Labs division dedicated incorporated a comprehensive numerous accolades for its
designing systems, services, and our users. Human-centered design data, thus missing the opportunity to to incorporating HCD methods user-centered design practice design and service innovation
products. It is intended to surface research intentionally surfaces ‘thick’ see how users behave in their native into product innovation, citing to the design and delivery of in health care delivery. In 2003,
and account for the needs of users, data over ‘big data,’ which is to say: context, hear the language they use it as their “go-to method for all of government digital ser- with the assistance of Silicon
which must be balanced with the it takes small numbers of users in their daily lives, and understand building the products and expe- vices.9 Due in large part to this Valley’s leading user-centered
constraints of technology, budget, (between 20 and 100) and delves the mental models they carry when riences that our customers need. dogged emphasis on identifying design agency IDEO, KP created
timelines, and stakeholder interests. deeply into their human needs, accessing our services.7 and designing for citizen needs, a dedicated internal innovation
desires, motivations, and behaviors. This human-centered method- the UK has collapsed all of their group, tasked specifically with
It is a tool intended to put the users Finally, HCD is not a replacement ology, coupled with a “fail fast” federal websites into a single exploring the applications of
at the table with key decision makers, Where quantitative studies often for agile technology development attitude, allows Capital One to digital platform—gov. uk—which Human-Centered design in
prioritizing user needs among the draw from large sample sizes to process--it is a complementary “quickly identify, build, and test allows users to register to vote, healthcare settings.
determining factors driving any uncover statistically significant process which often leads into agile our way to success.”8 pay their taxes, apply for a driver
product or service project.6 data, and focus groups and online development. HCD doesn’t prescribe The team has produced signif-
license, government benefits and
feedback forms gather customer a development methodology, but icant successes for its parent
more on a single page.
opinions, ethnography and design instead advocates for iteration and company, including an initiative
research are intended to comple- the user validation also prioritized to reduce medication errors
ment this information with a deeper in agile sprint cycles. which has saved KP $965,000
understanding of the nuanced and in its first year and increased
complex lives of customers. employee satisfaction and
patient peace of mind.10
DESIREABILITY
(HUMAN VALUES)
HUMAN-CENTERED DESIGN TOOLS
FEASIBILITY VIABILITY
(TECHNOLOGY) (BUSINESS)
5 6
CHAPTER 1 “Great products arise out of listening to
A Pilot in
[people] describe their moments of deep
personal pain, as well as profound joy—
paying attention to what motivates and
at the VA
alleviate their pain and maximize
their happiness.”
LUCKY GUNASEKARA,
COFOUNDER OF VULCAN LABS,
HEALTH IT INNOVATION NONPROFIT 11
So we decided to get out of the We built a rich understanding of From our research, a narrative about
The ways in which people come into As a service-delivery government From within our organization, we
building and speak with the users what characterizes their needs, and the veteran experience of the VA
contact with VA services, as with any agency, unlike comparable service cannot fully understand what it feels
of our services: Veterans and their gathered a nuanced picture of what emerged — a narrative which empha-
other service, are defined by small providers in the private sector (like like to approach our services. We are
families. Using the research tools of a VA services feel like to the men sizes the need for a VA that excels in
moments which build or breakdown banks, insurance companies, or acquainted with the acronyms, we
Human-Centered Design process, we and women who look to us in their customer service.
trust, that embrace what we have to health care providers) the VA does know the business lines and service
met with Veterans across the country transitions out of service and civilian
offer or create distance. They fore- not compete for the business of offerings. We may think a sign is
in their homes, with their families, lives. Some findings surprised us,
shadow relationships to come, and our customers. As a result, we may clear or that a form makes sense. Yet
at work and play. We heard stories while others reinforced existing
define the value our users — take for granted the loyalty of our we, the dedicated people who deliver
about their experiences with the suspicions.
America’s Veterans and families — customers and miss the opportunity vital services to Veterans, cannot
VA and how our services fit into the
will expect from their VA experience. to understand their core needs and fully grasp what it feels like to access
fabric of their lives.
motivations. these services — unless we ask.
7 8
1 // PILOT IN DESIGN RESEARCH AT THE VA
Methods
Oregon
feel like for Veterans?
Texas Jared Spool, a leading usability researcher,
Washington, DC
explains the value of research which facilitates
West Virginia
the observation of human behavior:
ACTIVITIES
CONTEXTUAL INQUIRY: This project piloted what is often We conducted user research activities “Users can’t describe activities that they
RESEARCH RESPONDENT
In-person individual and group referred to as the ‘discovery’ phase with 44 Veterans across geographic don’t focus on. When you have an audience
BREAKDOWN
interviews, in which our researchers of a user-driven design process – the locations, socioeconomic demo- that is experienced at what they do, they
met with Veterans in the context of often don’t pay attention to the small steps
initial research and analysis phase into graphics, age and eras of service. We AGE # RESPONDENTS
their lives - at home, at work, in social involved. An outside observer will see these
the needs and behaviors of users and traveled to 12 locations in 9 states
settings, etc. 18-29 8 ‘unspeakables’ and can document them in
user experience of existing services. over the course of three weeks,
ways that the participants can’t. It’s these
SERVICE TRIALS: connecting with Veterans through 30-39 14 details that will make the user experience
Shadowed users as they attempted organizational ties, grassroots com-
40-49 7 feel natural and well considered.
to access existing digital services or DISCOVER munities, and informal networks.
tools, observing behavior, pain points, 50-64 8 Innovation happens when the designers get
RESEARCH During this time, we performed
expectations, etc. direct exposure to the users’ entire context
SYNTHESIZE 7
qualitative ethnographic and design 65+
CUSTOMER JOURNEY MAP:
DEFINE and its subtle variations and accidental
activities, driven by a robust and
Translated the steps a user currently
similarities. Some of the most innovative
evolving set of questions. We met LOCATION # RESPONDENTS
takes through a system or service,
designs in the last 5 years are the result of
Veterans and their families in the paying attention to the little details in the
identifying the highs and lows of the RURAL 16
places where they access their services: user’s context.
experience from their perspective.
DESIGN in their homes, communities, offices SUBURBAN 9
PERSONAS: and social venues. ‘Intuitive’ interfaces are easier to build when
URBAN 19
Developed fictional archetypes of VA designers have a deep understanding of the
users which represent stories, needs, Using design thinking and service users’ context, terminology, and processes.
behaviors and characteristics of the design practices, we then mapped, SOCIOECONOMIC # RESPONDENTS It’s the combination of these three elements
real users interviewed. visualized and synthesized our that make an interface seem intuitive,
findings, which are detailed in this WORKING CLASS 12 because the familiarity to users is already
USER NEEDS: DELIVER
report. MIDDLE CLASS 27 built in.” 12
Generated a list of broad Veteran
needs and design considerations.
MIDDLE/UPPER 5
9 10
CHAPTER 2 Businesses in the private sector know In order to create similar experiences Through our research we quickly
Meet VA’s
that their customers have different for Veterans using VA services, we learned that the ways in which Vet-
needs, habits, and experiences—and need to understand our users in new erans choose to engage with the VA
they make identifying and accommo- ways. At the VA, we often appropriately transcends traditional demographics.
dating these differences a priority. think to engage with our ‘customers’ We happened upon common patterns
Users
Companies like USAA enjoy deep along traditional demographic in how Vets prefer to be contacted, in
customer loyalty because their cus- distinctions: age, geography, era their use and comfort with technology,
tomers feel like the business treats of service, gender, etc. and in their deeper needs and desires.
them as individual people, commu- It became clear that that there are
Given that the VA provides services
nicating over channels and with a larger themes in the Veteran experi-
to people with varying needs, access,
language and tone that feels natural ence of VA’s services which can help
capacities and aptitudes, this pilot
and welcoming. us understand the different kinds of
allowed us to unearth patterns or customers we serve.
themes around these needs in a way
that can be useful in improving how
we serve Veterans and their families.
11 12
2 // MEET VA’S USERS
Personas
As a part of this pilot we set out to identify high level These personas are designed to help us begin to under-
trends in ways Veterans seek out assistance, use technol- stand that we are serving users who are seeking not just
ogy, take advantage of services, and react to challenging different services, but also varied degrees of contact,
interactions. Based on these patterns we have created a support, information, etc.
set of four profiles, or personas, that represent the kinds
For this exercise, we assessed Veterans modes of
of users with whom we spoke.
communication, channels, frequency, stated and
Each persona is an archetype based on commonalities observed needs, reactions to service experiences,
we observed amongst Veterans who exhibited similar military service, and analyzed observed behavior
behaviors and approaches to accessing VA services. and service experiences.
They are not categorized by positive or negative
experiences, but by shared expectations and needs.
PERSONAS
These profiles are called ‘personas,’ Personas are developed “with signifi-
a design tool that helps ensure that cant rigor and precision...we don’t so
programs, services and systems are much ‘make up’ personas as discover
designed for real users. Alan Cooper, them as a byproduct of the investiga-
pioneer of software interaction design, tion process.”13
coined the term, defining personas as
In drawing together users by the ways
a “hypothetical individual that takes
in which they engage with the service
on the characteristic of real users,”
at hand, we can identify trends and
representing real people throughout
ensure we are meeting the needs
the process of designing a service or
of the varied types of customers we
product.
serve.
13 14
2 // MEET VA’S USERS // PERSONAS
I just want quick I want a I just want quick I want a I just want quick I want a I just want quick I want a
transactions relationship transactions relationship transactions relationship transactions relationship
I’ll take care of it Do it for me I’ll take care of it Do it for me I’ll take care of it Do it for me I’ll take care of it Do it for me
I don’t use I use VA I don’t use I use VA I don’t use I use VA I don’t use I use VA
the VA services the VA services the VA services the VA services
DESIGNING FOR THE LIFER DESIGNING FOR THE TRANSACTIONAL DESIGNING FOR THE JUST-IN-CASE DESIGNING FOR THE INFREQUENT
Allow me to pause and ask questions, and to have access Explain VA benefits and services comprehensively and Offer straightforward information about VA benefits that Provide ways for me to learn about and access benefits
to a VA professional to speak with frequently and in a early so that life plans can made upon quickly post-ser- is easy to then communicate to others. Clearly articulate both through third parties (i.e at the bank when securing
timely manner. Include info about local Veteran support vice. Include lists of phone numbers, websites, resources, what is available, when, and to whom involved in my life. a home loan).
chapters in communications. Provide me with a single and why they are relevant. Auto-enroll when it’s possible.
Establish an online portal or phone system where both I will most likely use VA services if I can a) see the value
online tool or a call center where they can refill prescrip-
Present benefits as they relate to life events (school: GI Bill, Veteran and the VA can see that all of paperwork is for my life and b) accomplish my goals in convenient,
tions, see test results, and maintain all aspects of the VA
employment: Job resources, family: home loan). Visualize up-to-date and notify me if something is missing. simple service interactions. Offer me easy-to-use web-
needs. Give high level of feedback loops so that I can be
assured my request was submitted and is being handled. processes, timelines and how I should be prepared. sites and the ability to speak with someone.
15 16
2 // MEET VA’S USERS
User Needs
In examining the Veteran experience IN MY LIFE, I AM LOOKING FOR… I NEED THE VA TO...
of VA services, we sought to draw out
a common set of user needs which will
allow us to use as a basis for designing
Security for my future and family Treat me like a customer and Reach out to me on the timelines
an improved user experience.
• I want to be able to take care of my family deliver services in a way that which I am responsive to
These needs help us understand what • I want to have a backup plan just in case makes me feel respected
Veterans may be expecting from our
services as well as what larger motivations • I owe it to my kids to take care of myself • Connect with me in the moments that
• Hear and acknowledge me I will be receptive to, and understand
may be shaping their attitudes.
when I may be less receptive
• Don’t waste my time
A feeling of support • Earn my trust
• Keep looking for me if I’m not already
engaged
• A place to guide and offer direction, • Give me one person to answer
making things easier rather than harder • Engage with me the way I talk, think
all my questions who knows my story
in a time of transition or great need and interact, through channels which
• Set me up for success: set and I use most in my daily life
• Transitioning out of service is uphold accurate expectations
disorientating, and I don’t have an anchor
• My mentorship devolved when I begin
civilian life Offer services tailored
Make things easy for me to
understand. Give me clear for my needs
A sense of independence information, answers and
• I don’t want to need help directions • Serve me when I need help most urgently
17 18
2 // MEET VA’S USERS
Design research exercises Mental models are unstable, Given the scope of this pilot, a personal touch
may often seek to identify the based on “incomplete facts, we did not delve deeply into
‘mental model’ with which a past experiences and even this activity, though these Vets often lack information and awareness of what
user approaches a service. A intuitive perceptions,” and five considerations begin to VA services are available to them. They often don’t
‘mental model’ is defined as give us insight into “what people shed light on what we might feel ready to engage with the VA immediately after
someone’s understanding for pay attention to in complicated expect a mental modeling service, and thus aren’t receptive to outreach efforts
how a system works which then situations and...how people activity to uncover. out of the gate. When they do finally connect with
informed how they interact with approach and solve prob- the VA, across the board, Veterans cited a desire to
this system.15 lems.”16 be able to connect with ‘real people’ who will follow
up with them and know their story.
19 20
VETERANS SHARED WITH US EXAMPLES OF THE WAYS
IN WHICH THEY COMMUNICATE WITH THE VA
CHAPTER 4
Veteran Experience
MARCUS, PORTLAND OREGON
of the VA
Across the country, Veterans shared What follows is a summary of what But this is the story of how our
with us the ways in which seemingly we heard, observed and inferred customers currently make sense of
small interactions meaningfully during our three weeks of meeting what we have to offer — and it’s ever
shape how their experiences with with Veterans. It is a story that is not so crucial that we listen to how it
the VA. These moments can serve without its challenges - especially as feels from the outside.
to disrupt or reinforce the powerful those of us who know the VA well
We will offer an overview of findings,
public narrative about the struggles may feel frustration knowing that our
followed by details on the specific
of the VA. hard work is going unseen or unfelt.
themes that arose from our research.
21 22
3 // RESEARCH FINDINGS
A portrait of the
present day service experience.
From Oregon to Texas,
we met Veterans young and old
who shared an appreciation for
VA services matched with
frustrations. This is what we
observed about what the VA feels
like for Veterans across America...
For many Veterans, the VA conjures Veterans are not always ready to to take orders and not ask questions. Veterans are often looking for Veterans access VA services experiences that have shaped Veterans
up images of hospitals, wheelchairs, engage with the VA right after As Veterans using the VA, they are consistency and continuity in infor- through the channels most native lives. Across the board, Veterans
people in dire straits and reminders release. They often want distance met with systems which feel com- mation and people: changing doctors to their individual lives. Some of all backgrounds have positive
of military ties. These perceptions from their military experiences. But plex and processes so daunting— and points of contact fracture the re- Veterans have few complaints, while associations with customer service
often don’t match up with people’s with infrequent, inconsistent, and when they were expecting to be met lationship they were starting to forge others find that both phone and in the private and public sector that
actual experiences. Indeed, many are opaque communications from the by a VA that will be their ally., easing with the organization. The result is online services cause frustration. recognize their military service and
happily surprised by the services they VA, they often struggle to engage their transition that many Veterans do not feel a Many use the VA website for just one provide personalized and respon-
receive — though frustrations about with the VA when they are ready. sense of control over and access to or two specific services, and otherwise sive interactions, which serve to
Veterans want to be leveled with
how those services are delivered It may take multiple nudges and the their own information, and must tell have no interaction (and often no build trust among Veterans.
and to feel respected. Long hold
remains high. final push often comes from friends, their story over and over again. Vets idea) what else is available to them
times and pages of dense text makes At the end of the day, most Veterans
fellow Vets, VSOs, or family. often request one single point of online.
Veterans are looking to regain or Veterans feel like the VA isn’t putting aren’t looking to the VA to change
contact and one single place to go
maintain control of their lives, finding First contact with the VA is really their needs first. They’re often willing Veterans recognize that the VA is their lives— they are simply looking
to view all their information and
stability and a place in society. The only meaningful and memorable to put in the work to activate their serving a broad and diverse group for a smoother transition. However,
perform all their interactions.
VA is a helpful means to this end. if something bad happens, and the benefits and are understanding of of people with varying needs, but that need is at times left unmet in
It can hinder or accelerate, facili- impact of a negative first experi- the constraints and pressures facing Together, the feeling of complexity it seems that VA services don’t always trying to access VA services. Many
tate or disempower. ence can be lasting. When Veterans the VA. But they want to have clear and inconsistency reinforces a sense feel like they’ve been designed to Veterans describe contacting the
do reach with the VA, they are often expectations of what they need among Veterans that they can’t address targeted needs. Many feel VA as ‘talking into a black hole’.
faced with a paradox of how they to do, digestible information in navigate VA services on their own, frustrated that those with quick turn- Unreturned phone calls, loops
must engage with the organization. language they understand, and and thus they turn to ‘insiders’ to around needs are often in the same of voicemails and redirected
As members of the military, they are tools which are easy to use and help them — Congressional offices, queue as those with severe needs. questions feels to Vets like the VA
accustomed to be being told what to do, find. non-profits, or other Veterans with system doesn’t care about them.
There is some feeling that VA materi- Many Veterans feel positively when
VA experience.
als and systems are designed without they are able to connect with VA staff
an understanding of the military - it creates a human touch in
an otherwise impersonal system.
23 24
3 // RESEARCH FINDINGS
INSIGHT 3:
There is a lot of good
happening, and we need
to play off of what is
working well.
25 26
3 // RESEARCH FINDINGS // KEY INSIGHTS
INSIGHT 1:
27 28
3 // RESEARCH FINDINGS // KEY INSIGHTS // INSIGHT 1: CONFUSED, OVERWHELMED + UNABLE TO NAVIGATE
OBSERVATION
• I need my time to be It’s hard to reach people, VA phone lines are a I don’t have a consistent There is often little
respected. and when I do, they often frustrating experience. point of contact. I have to to no follow-up.
aren’t helpful. keep repeating my story.
• I need to know who to
call for answers or for The Veterans we spoke with said As with any service, our customers Veterans told us that they often have Veteran expressed disappointment in Veterans also interact with the VA
help. that when they call the VA helplines want to pick up the phone and call to talk to multiple different people to the lack of acknowledgement and fol- in-person, through individuals
• I only want to tell my the person they speak with often someone for help when they have get a simple response, and that each low-up they receive when communi- at local offices, or over the phone
story once. does not have an answer to their a question or a problem. The VA time they speak with someone they cating with the VA on various levels. through customer service lines.
• I need anyone who is question(s). Many Veterans feel they has dozens of phone numbers, yet have to re-hash their entire story, On a technical level, when Veterans Many Veterans told us that there was
working with me to are passed from person to person in according to the Veterans we spoke instead of it being documented submit something to the VA there is no follow-up from the individual
know my story and order to get a simple answer. with, the waiting times are too long, internally. Veterans assume there is a rarely, if ever, acknowledgement of they spoke to. We found this across
my history. and they often do not receive the centralized system where customer that action. Many Veterans said that service lines and modes of commu-
“I have a housing allowance and help that they need. service agents can see a Veteran’s after submitting an application, there nication, from email and phone, to
• I need the people
education benefits. When I got a history, so when they must contin- was no confirmation that it had been
helping me to have in-person office visits.
new bank account but there was “I used to be able to call my ually rehash their stories upon each
the answers to my received, so they were often unsure if
no way to easily say ‘I have a primary care doctor, or the nurse
questions. encounter, they become frustrated and their application had even made it to “Our local VA rep doesn’t pick up
new bank account.’ You have to in the women’s clinic. Now you lose confidence and trust in the VA. the right place. the phone. I leave a message and
• I need confirmation call up, wait 45 minutes-- that’s have to call the central line and he never calls me back.”
after I submit paper- optimistic--just to spend two they don’t put you through to “The turnover in doctors is high JOSE, RURAL INDIANA
work. minutes with an operator to do the clinic: they take a computer – I’ve been through like 4 of them
• I need the people help- something I should be able to do message and send it over to the in a year.” “When you call and make contact
ing me to do what they online. Nobody I talked to could clinic, then the clinic calls you
with someone, they usually ask
give me a straight answer on ALICIA, PORTLAND OREGON
say they will do. back, but if you miss the call
you to email someone and then
where I go for this.” then you have to go through the
“A case person that is dedicated when you do that, you feel like
process all over. It can turn into
MARCUS, PORTLAND OREGON to YOU would be ideal. Someone that email never gets returned.”
days of trying to get a hold of
somebody.” who knows you, your history, GEORGE, DAYTON OHIO
your issues, etc…”
MICHELLE, CHICAGO ILLINOIS
ANDRE, RURAL OREGON
29 30
3 // RESEARCH FINDINGS // KEY INSIGHTS // INSIGHT 1: CONFUSED, OVERWHELMED + UNABLE TO NAVIGATE
b. Information is confusing, inconsistent and often c. I don’t know what to expect along
hard to find. I can’t figure out what I’m qualified for. the way and I can’t figure it out by myself.
31 32
3 // RESEARCH FINDINGS // KEY INSIGHTS // INSIGHT 1: CONFUSED, OVERWHELMED + UNABLE TO NAVIGATE
d. Waiting is synonymous
with accessing VA services.
33 34
3 // RESEARCH FINDINGS // KEY INSIGHTS // INSIGHT 1: CONFUSED, OVERWHELMED + UNABLE TO NAVIGATE
Journey to
DESIGN TOOLS:
trajectories in the process of engag- from service until they have been through in engaging with your company” and “highlight the flow of the customer
ing with the VA. We translated those approved for VA benefits. CUSTOMER — is a helpful tool for documenting a experience—from the ups and downs
VA Services
users’ path through a service20. These along the way to those critical pain points
paths into touchpoints in a service- JOURNEY MAP
member’s transition and captured KEY maps can be used to identify the inter- where our attention and focus are most
actions which cause users most discon- essential.”21
the positive and negative interactions
associated with each stage of the
Negative Positive
transaction. The result is a customer experience experience
TRANSITION
TRANSITION
OUTOUT
OF OF
SERVICE
SERVICE DECISION
DECISION
TO TO
APPROACH
APPROACH
VA VA SEEK
SEEK
INFO
INFO
ABOUT
ABOUT
VA SERVICES
VA SERVICES DECISION
DECISION
TO TO
PURSUE
PURSUE
VA SERVICES
VA SERVICES
Decides
Decides
to sign
to sign
Check
Check DoDDoD Looks
Looks
to to up up It seems
It seems
Attend
Attend Learn
Learn LooksLooks
to to
out out transfers
transfers about
about
VA VA 3rd 3rd important/helpful/
important/helpful/
TAPTAP the the
VA VA
medical
medical my info
my info services
services parties
parties necessary/worth
necessary/worth
it it
training
training for info
for info
apt.apt. to VA
to VA for info
for info
Decides
Decides
not not
to to BAILS
BAILS
signsign
up up
I wasn’t
I wasn’t
qualified
qualified
Didn’t
Didn’t
seemseem
worth
worth
Nobody
Nobody
carescares It took
It took
a I was
a I was
ableable I hadI had
to beto be Vague,
Vague,
confusing,
confusing,
unclear
unclearA friends/family
A friends/family
members/
members/ I can’t
I can’t
figure
figure
out outI found
I found
enough
enough I gotI bad
got bad
I gotI the
got help
the help
the effort
the effort
to apply
to apply
I’m leaving
I’m leaving longlong
timetime
to get
to the
get the proactive
proactive
to make
to make info info
fromfrom
VA VAfellow fellow
Vet gave
Vet gave
me some
me some
info info whatwhat
I’m eligable
I’m eligable
for forto get
to started
get started advice
advice
I needed
I needed
VA facility
VA facility
was was
TAP TAP felt useless to get
felt useless to my process
get my process sure sure
VA had
VA had
my my I want
I want
to know
to know
moremore
but butVSOVSO or non-profit
or non-profit
reached
reached
out out I don’t
I don’t
knowknow
who who
to call
to or
call orI found
I found I wasI was
given
given
I learned
I learned
through
through
appoint-
appoint-
started
started documents
documents too far
too far
I wasI was
encouraged
encouraged I don’t
I don’t
knowknow
where
where
to goto goI learned
I learned
whilewhile
I wasI was
in service
in service where
where
to start
to startsomeone
someone
to to poorpoor
message
message
boards
boards
mentment
to stay
to stay
in service
in service
by by I know
I know
about about
one one
thingthingThe The
VA reached
VA reached
out to
outme
to me Overwhelming
Overwhelming
amounts of ofhelphelp
amounts me me information
information
online
online
my peers
my peers
or TAP
or TAP but nothing
but nothing
else else info info
+ text+ textI figured
I figured
it outit out I Googled
I Googled
my my
My bank/employer/school
My bank/employer/school
etc. etc.
I haveI have
no idea
no idea
what’s
what’s
available
available
to meto meinformed
informed
me about
me about
a VAaservice
VA service Info Info
+ answers
+ answers
are hard
are hard to findafterafter
to find a while
a while questions
questions
I didn’t
I didn’t
knowknow
VA facility
VA facility
was was
nearbynearby Printed
Printed
materials
materials
are are A VSO
A VSO
etc. etc.
was was
outdated/irrelevant
outdated/irrelevant
to me to me ableable
to help
to help
me me
I haven’t
I haven’t
heardheard
fromfrom
the VA
the VA
RECEIVES
RECEIVES
APPLICATION
APPLICATION
DECISION
DECISION SEEKS
SEEKS
ASSISTANCE
ASSISTANCE BEGINS
BEGINS
APPLYING
APPLYING
for VA
for SERVICES
VA SERVICES
SUBMIT
SUBMIT SUBMIT
SUBMIT SUBMIT
SUBMIT
METHODS
METHODS
OF APPLYING
OF APPLYING
My My
applica-
applica- My My
tiontion
waswas problem
problem I figured
I figured
I was Inot
was not
accepted
accepted waswas able to
able to I was Iable
was to
able to it out!
it out! via via
ON PAPER/
ON PAPER/
solved.
solved. speakspeak
with with speakspeak
with with SeeksSeeks
IN PERSON
IN PERSON
ONLINE
ONLINE THIRD
THIRD
someone
someone
at at someone
someone
at at help from
help from PARTY
PARTY
Seek Seek
help help the VA
the VA a Third
a Third
the VAthe VA
TookTook
a very
a very I’m in!
I’m in! from from PartyParty
elected
elected
longlong
timetime VeryVery official
official
SpentSpent
personal grateful
personal grateful
$ while
$ while
waiting for my
waiting for my No one
No one I had
I had
a a Inefficient
Inefficient Not Not
user user
It was
It was
not not TheyThey
did itdidThey
it They
did itdid it
Could
Could
not find
not find TheyThey
didn’t
didn’t
TheyTheywerewere TheyThey
werewere
helpful.
helpful.
for benefit to tobenefits
for benefit benefits
I’m I’m
TheyThey could
could someone
someone
who who havehave
answers ableable
answers to to problem
problem
TookTook
a very
a very friendly
friendly
as bad
as bad
as as wrong
wrong all for
allme
for me
I hadI had
one one
pointpoint
of of
come
come
through
through frustrated
frustrated
it sorted
it sorted
it it helphelp
me. me. could
could
helphelp
me me GaveGave assistassist
me me longlong
timetime Difficult to Ito
Difficult hadI had Lots Lots
of They
of They
helped
helped
me the
me the contact
contact
was was
so hard
so hard
out for
outmefor me navigate
navigateexpected
expected backback
& forth
& forth
me enough
me enough
Call Call
was was
nevernever run around
run around
The The Didn’t
Didn’t
knowknow
returned
returned I wasI was call-back
call-back SeeksSeeks
help from
help from
the VA
the VA where
where
to find
to find Steps
Steps
werewere TheyThey
weren’t
weren’tto get
to get
on hold
on hold
Always
Always
got got for afor
long
a long feature
timetime feature & send
& send
formsforms unclear
unclear to dotoitdo it started
ableable started
My applica-
My applica-
BAILS
BAILS machines
machinesinstead
instead was was all for
allme
for me
tiontion
waswas Never Never
helpful
helpful BAILS
BAILS
denied
denied It wasn’t
It wasn’t
worthworth
it it of people
of people followed
followed
up up TheyThey
weren’t
weren’t
Confusing
Confusing
& hard
& hard
to use
to use helpful
helpful
I’m frustrated,
I’m frustrated,
not not
goinggoing
to continue
to continue
It took
It took
a very
a very
longlong
timetime
to to applying
applying
get this
get answer
this answer
I’m unhappy
I’m unhappy
35 36
3 // RESEARCH FINDINGS // KEY INSIGHTS
INSIGHT 2:
37 38
3 // RESEARCH FINDINGS // KEY INSIGHTS // INSIGHT2: SMARTER ENGAGEMENT
39 40
3 // RESEARCH FINDINGS // KEY INSIGHTS // INSIGHT2: SMARTER ENGAGEMENT
OBSERVATION OBSERVATION
• I’d like to be able to Veterans have varied preferences and needs for • I’d like to know what Outreach from the VA
communicate with the communicating with the VA, and rising expectations benefits and services seems unstrategic and
VA through platforms of digital service options. are available to me inconsistent
that I use. • I want to know that
• I’d like to be able to For some, a natural form of contact When asked about their favorite ser- I’m not missing out on Few Veterans we spoke with have Of the Veterans who do recall
choose and modify my is email, for others it’s the phone, yet vices, many pointed to the flexibility something many recollections of direct outreach hearing from the VA, the outreach
preference for commu- it feels to Veterans that VA’s default of USAA or their banks, which are • I want to know where from the VA through any channel: was not consistent. Some received
nicating with the VA communication is paper. While there increasingly offering customers op- and when I should by mail, phone, or in person. This communications by mail, others have
over text, phone, email, are those for whom paper remains a tions for text, email, phone, and mail expect to hear from the indicates that either (1) not enough an ongoing relationship with their
or mail. reliable back-up for personal records, VA outreach is occurring, (2) the out-
communications. VA representative.
many Veterans — young and old reach is not clearly tied to the VA, or
alike — expressed frustration with (3) the outreach is not memorable in
the paper-based communications of “I want to call or text or email, any way. “Our local VA Rep didn’t even
the VA. Even when Veterans contact but the VA always responds by know there was a VFW here in
the VA digitally—landline, mobile, or sending me something in the our little town. We had to ask
mail. I can’t easily change my
email—they still receive responses by him to come speak with us.
address in VA systems some-
regular mail. Many suggested a single Seems like it should be the other
times so bills get mailed to the
place online where they can access way around.”
wrong address and then I’m
and manage their VA information. screwed.” PAUL, RURAL INDIANA
41 42
3 // RESEARCH FINDINGS // KEY INSIGHTS // INSIGHT2: SMARTER ENGAGEMENT
43 44
3 // RESEARCH FINDINGS // KEY INSIGHTS
INSIGHT 3:
45 46
3 // RESEARCH FINDINGS // KEY INSIGHTS // INSIGHT3: GOOD THINGS ARE HAPPENING
“In 2005 I went back to the VA “I talked to a lot of people “The staff there at the clinic...
after many years and it was who thought it was not worth I’m gonna call them excellent.
amazing. It’s totally different-- it. But for me, I’m in a 6 year I’ve never had to wait for an
a different building, different PhD program… it’s worth the appointment. i’ve never had any
attitude… it’s much better.” headache.” problem.”
SAMANTHA, BOSTON MA LUCAS, AUSTIN TEXAS TRAVIS, RURAL INDIANA
47 48
CHAPTER 4
A Powerful
A user-centered focus
yields powerful insights
Opportunity
for Veterans to interact with the VA a large number of VA’s users — and employees is often lost in an unsat-
through this kind of engagement. indeed, the methodology is focused isfying, and at times frustrating or
Many expressed gratitude and an on depth over breadth — resound- negative, customer experience. While
increased sense of faith in an organi- ing themes and trends emerged that this project never sought to test the
zation that will willing to spend time we suspect would be reinforced by full Human-Centered design pro-
to Scale
understanding their perspectives and further investigation. cess—merely a pilot of its research
hearing their stories. approach—it has indicated that scal-
This exercise proved a valuable ing a user-centered approach to the
The pilot offered an opportunity to exploration into what is possible to design and delivery of our services
test a Human-Centered Design ap- gain from engaging with our cus- has the potential to yield significant
proach to user research for VA’s ser- tomers in their homes, observing impact for improving our customer
vices, programs and customer inter- their behaviors, hearing their needs, satisfaction.
actions. At the very least, we gained and applying tools of private sector
“I can tell you...that in all my time with the VA no one has a richer understanding of notions or customer-focused innovation to We highly recommend that the VA
ever asked me questions like this before. I really appreciate it. suspicions. Simultaneously, in just a
few short weeks, with a small team
the challenges of our large public
institution.
examine opportunities to incorporate
tools of design research into both
It’s so good to know my opinion is useful and important.” and limited budget, we were able to large and small scale projects and
SUSAN, SUBURBAN OREGON identified significant and meaningful strategic decisions making efforts.
49 50
4 // LESSONS FROM THE PILOT
Invest in growing Create consistent materials Identify and test Investigate gaps in
a warm, responsive and with simple, easy-to-find info opportunities to offer Veteran engagement
transparent customer about benefits, eligibility, personalized and and explore strategies
service system. and contact information. customizable options. for smarter outreach
• A single point of contact assigned to a Veteran • Execute a robust research project, including
• Redesign and consolidation of all Veteran- • Provide options for users to indicate
that knows their full history and needs. both market research, user-centered design,
facing digital services and platforms into a preferred mode of contact with the VA
and engagement analytics to understand
• A single online dashboard with one login single website, creating standard language (via phone, text, email, etc.)
where we are currently successfully reaching
that contains all Veteran information and and design templates, to be driven by an • Pilot ‘healthy clinic’ models to explore health Veterans, what communities we are categor-
their benefits, health information, records, exhaustive user-centered and agile develop- care delivery in ways which serve both pre- ically failing to reach, what times in peoples’
documents and services history. ment process ventative and urgent care needs. lives they are most receptive to VA outreach,
• A customer service system that is in line • For every service offering, design clear and what channels are most effective for
• Stand up a central CRM database that meets
with the highest industry standards. step-by-step instructions in plain language reaching different members of our constitu-
industry standards, which tracks user history,
that can be used on any VA platform. Use ency.
• Consolidate phone lines, and improve call demographic factors, technology usage,
common visual and written language so that
center efficiency and service. preferred mode of contact, etc., tailoring • Perform an ecosystem assessment of stake-
these step-by-step guides are consistent engagement to needs tracked over time. holders currently engaged in Veteran out-
• Explore and test options for communicating across the board.
realistic timelines for each process which reach to identify gaps and opportunities for
• Evolve the VA’s Veteran-facing communication ensuring stakeholders are distributing and
requires some back-and-forth between the
strategy, training employees across the agency disseminating consistent and up-to-date
Veteran and the VA.
on content strategy, write and deliver user- materials.
• Create standards of customer service to friendly written material.
require follow-through and follow-up. • Pilot an electoral campaign-style field out-
• Provide basic design training and resources reach initiative, mobilizing local partners to
to offices responsible for producing web and employ metric-driven grassroots outreach
print materials, with an emphasis on simple, strategies to enroll Veterans and distribute
clear, and digestable visual materials. information.
51 52
Exploring next steps End Notes
for integrating user-centered 1. “About IDEO.” IDEO, 1 Jan. 2014. Web. <http://www.ideo.com/about/>
Efforts to weave Human-Centered Design principles into the 4. Pratt, Andy, and Jason Nunes. Interactive Design: An Introduction to the Theory and Application of Us-
fabric of VA operations should revolve around both people and er-Centered Design: Rockport Publishers, 2012. Print.
process, and stretch across multiple fronts. This pilot tested the 5. Ibid
initial ‘discovery’ research phase of the HCD process. The next
6. Ibid
step in scaling up HCD efforts should include larger pilots that
test complete HCD cycles -- from discovery through to ideation, 7. Spool, Jared. “Field Studies: The Best Tool to Discover User Needs.” N.p.,
prototyping, testing, iteration and on-going release and refine- 13 Mar. 2007. Web. <http://www.uie.com/articles/field_studies/>.
ment -- ideally on tangible Veteran-facing products or programs. 8. “About Capital One Labs.” N.p., n.d. Web. <https://www.capitalonelabs.com/#/about >.
Integrating tenants of this methodology across the VA will indeed 9. “Service Manual: User-Centered Design.” Gov.UK, n.d. Web. <https://www.gov.uk/service-manual/user-cen-
tred-design>.
require significant planning, collaboration and design. VACI con-
siders this pilot the first step of a longer journey, and the begin- 10. McCreary, Lew. “Kaiser Permanente’s Innovation on the Front Lines.” Harvard Business Review, 1 Sept. 2010:
ning of a conversation about how to build more effectively to mee n. pag. Print.
the needs of our customers. We are eager to help our organiza- 11. Toner, Beth. “Listen Up: Why Innovators Need to Listen to Consumers.” Robert Wood Johnson Foundation, 1
tion continue to evolve and grow as an effective and meaningful May 2013. Web. <http://www.rwjf.org/en/blogs/pioneering-ideas.html>.
source of support to Veterans and their families. 12. Spool, Jared. “Field Studies: The Best Tool to Discover User Needs.” N.p., 13 Mar. 2007. Web. <http://www.uie.
com/articles/field_studies/>.
13. Cooper, Alan. Inmates Are Running the Asylum, The: Why High-Tech Products Drive Us Crazy and How to
Restore the Sanity. Sams, 1998. Print.
14. “UK Government Digital Service Design Principles.” Gov.UK, 1 July 2012. Web. <https://www.gov.uk/de-
sign-principles#first>.
15. Davidson, Mary Jo, Laura Dove, and Julie Weltz. “Mental Models and Usability.” Depaul University, Cognative
Psychology: n. pag. Print.
16. Weinschenk, Susan. 100 Things Every Designer Needs to Know About People. Pearson Education, 14 April
2011. Print.
17. Bredouw, Minnie. “Humanizing Data in Telemedicine: Making Sense of It All.” IDEO, 23 Oct 2013. Web.
<https://www.ideo.org/stories/making-sense-of-it-all>
18. Kolko, Jon. Exposing the Magic of Design: A Practitioner’s Guide to the Methods and Theory of Synthesis
(Human Technology Interaction). Oxford University Press, 28 Jan 2011. Print.
19. Kolko, Jon. “Information Architecture: Synthesis Techniques for the Muddy
Middle of the Design Process”. In the 23rd International Conference on the Beginning Design Student Pro-
ceedings. 2007. Web. < http://www.jonkolko.com/writingInfoArchAsSynthesis.php>
20. Richardson, Adam. “Using Customer Journey Maps to Improve Customer Experience “ Harvard Business
Review, 15 Nov 2010. Web. <http://blogs.hbr.org/2010/11/using-customer-journey-maps-to/>
21. Flom, Joel. “The Value of Customer Journey Maps: A UX Designer’s Personal Journey.” UXmatters, 7 Sept
2011. Web. <http://www.uxmatters.com/mt/archives/2011/09/the-value-of-customer-journey-maps-a-ux-
designers-personal-journey.php>
53 54
Photo credits
All photos are images of real veterans and their families. Photos of interviewees of this study were taken with
permission of the interviewee. Additional photography acquired through the Creative Commons license:
p. 11
“Veterans Day in North Charleston” by North Charleston is licensed under CC BY 2.0 (https://flic.kr/p/huj6XJ)
p. 12:
“State Fair honors military veterans” by Minnesota National Guard is licensed under CC BY 2.0
(https://flic.kr/p/d3aVAQ)
p. 15:
“Al at the VFW Bar” by Susan Sermoneta is licensed under CC by 2.0 (https://flic.kr/p/jDg5JQ)
p. 37:
“West Bend Soldiers return home, end era in Iraq for Wisconsin Guard” by Wisconsin National Guard is licensed
under CC by 2.0 (https://flic.kr/p/aHJbhK)
p. 44:
“Soldiers’ and Sailors’ Home” by Pennsylvania National Guard is licensed under CC by 2.0
(https://flic.kr/p/khBSc9)
p. 45:
55 56
www.innovation.va.gov