Unlocking Our Shared Humanity:
Applying Human-Centered Design to
Regional Health Improvement Efforts

The Health Improvement Partnership (HIP) of Santa Cruz County is one of the newest members of NRHI. HIP supports healthcare system improvement, emphasizing prevention and equity, through integrated, coordinated approaches designed to yield better outcomes for patients, staff, providers, and the community overall. HIP seeks to identify common ground, establish organizational partnerships, and take collective action to remove barriers to individual and community health and improve well-being throughout the Santa Cruz County and the central coast region of California. The mission of HIP is to be a contributor to a larger movement that is advancing systems change to improve healthcare for everyone in the U.S.

Human-centered approach towards building partnerships

In 2015, the Institute for Health Improvement (IHI) published a series of white papers with case studies of regional organizations working on achieving its Triple Aim. The Health Improvement Partnership (HIP) of Santa Cruz County was one of the featured organizations. In interview style format, the paper managed to showcase that HIP originated with a very clear goal to bring healthcare payers, purchasers, and providers together. “[T]he local care system was especially fragmented… there was no large player driving expectations and practices,” (Craig, C. 2015).

With HIP’s incorporation in the mid-2000s, health and healthcare organizations from the Santa Cruz County area could now convene, clarify a common vision, and establish a shared strategic focus. The overarching goal that has guided HIP’s work for the past 15 years is to ensure that everyone within Santa Cruz County has access to quality care regardless of identity or financial circumstance.

The language and the strategies of working towards this ambitious goal have been evolving, adapting to include innovative thinking and speaking with partners. For example, the 2015 IHI paper uses stakeholders, collaborators, and the coalition leading the action towards outcomes when describing the work of HIP. Five years later, Maritza Lara, HIP’s Program Manager, used language that compared HIP to a human body, a metaphor that personalized and made more comprehensive HIP’s efforts.

The methods and programs HIP develop to improve work done, emphasizes a human-centered approach. From conducting listening tours that humanize the experience of care within the entire care ecosystem – from patient through billing administrator – to working with leaders of local healthcare systems to facilitate self-reflection and self-compassion as an antidote to the prevailing norm of healthcare CEOs’ self-expectation: being “super-human” CEOs, HIP’s approach aims to center shared humanity.

The ability to think about others, especially those in leadership positions, as human beings first, had a major impact on how HIP’s partners at Safety Net Clinics responded to the outbreak of COVID-19 cases in the communities they serve. “[T]here was no, “OMG, who are you??,” says Maritza Lara. Existing relationships were strengthened, and new ones were rapidly established due to the foundational trust HIP has cultivated. People – led by those in leadership – were more eager to focus on shared aims and other similarities rather than differences. In pandemic response, this has manifested as even more proactive information and resource exchange, from fliers describing services and learning opportunities to actual swaps of PPE inventory. Beyond the pandemic, HIP intends to build upon this spirit of mutual aid that aligns resources toward larger shared goals, including the ultimate goal of responding to everyone who needs healthcare with timeliness and patient-centered approaches.

While not explicitly framed as “advancing health equity,” HIP’s close work with healthcare ecosystem players accrues toward the aim of centering health equity. That is one of the reasons why HIP’s partners eagerly share their gratitude for all the work HIP has been doing before and even more so during these unprecedented times:

There has never been a time when collaboration and communication are so essential. During this pandemic, HIP has gracefully and intentionally pulled from its experience of providing an arena for the local health care system to come together. Having such a strong history of collaboration during “normal” times made pulling together even more closely during this difficult time seamless. HIP is the reason that Santa Cruz is known as being unusually collaborative.

~ Amy Peeler,
Chief of Clinic Services at the County of Santa Cruz Health Services Agency (HSA)

HIP’s strategies to build long-lasting partnerships

For HIP, finding novel ways to hear partners’ voices is a major part of strategy development. Since 2015, HIP’s “listening tours,” recently coupled with human-centered design (HCD) process, shape everything from training curriculum, to educational events, to monthly leadership council meetings, to HIP’s annual community forum.
“We conduct ‘listening tours’ every year to hear how community health center staff are doing, to convey that their experiences matter and that HIP is committed to ensuring that it informs policy, resource allocation, and practice,” said Maritza. “When we listen to our partners, we know what resources are more useful to them.”

However, listening to partners to find their needs is not enough. Effectively integrating key aspects of feedback is just as important. HIP’s uses the five stages of HCD – empathize, define (the problem), ideate, prototype, and test – to apply feedback to practice improvements. This process not only allows HIP to be effective listeners and utilize data well, it also serves as a “reality check,” ensuring that what health center staff really need – rather than what HIP might think they need – takes precedent.

Another application of HCD has been focused on the acknowledging the humanity and vulnerability of leaders, especially under the pressures of the pandemic. Leveraging established trust and the methodology of HCD, HIP recognized that burnout among middle managers at health centers was at a tipping point toward massive layoffs of people within leadership positions. In response to this impending workforce crisis, HIP is developing a focused curriculum on change management and bringing in a well-recognized leadership coach to help partners navigate large-scale change.

Conclusion: HIP and the National Health Centers Week

In a series of five human-centered stories, HIP shared the organization’s pride and appreciation for the work of their partners from the Safety Net Clinics within their communities. Each story focused on 2020’s National Health Center Week focus areas – public health in housing, healthcare for the homeless, agricultural workers and children’s health, patient, stakeholder, health center staff appreciation.

The stories not only gave visibility of the HIP community partners – the health centers, food banks, governmental entities, and the volunteers – but they also highlighted what was different this year. From hotels that opened their doors to help individuals living in tight living conditions to self-isolate if COVID-19+, to the tenfold increase in fresh food distribution to help those hit the hardest by COVID, to the changes in established processes and the adoption of technological innovations to observe physical distancing – these five stories showcase the strong relationships and corresponding resilience that HIP’s partners have built over the years. in part due to HIP’s ongoing efforts and its strategy of uplifting similarities, we have stronger and more lasting impact on the health of our communities.

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