As part of SVA Products of Design’s partnership with Veterans Affairs (and held through the Design Research and Integration class taught by IDEO’s Lawrence Abrahamson), designers Smruti Adya, Bernice Wong, Lassor Feasley, Juho Lee, Christopher Rand, and Kuan Xu designed a number of solutions to improve women veterans’ experience in three different areas specific to visiting the VA Hospital: Transportation to the hospital; Wayfinding once in the building; and Pre-appointment communications.
The team was given the prompt of understanding why there was a higher rate of missed appointments within the women’s clinic of the hospital as compared to the other departments. They conducted extensive interviews with veterans (those who do and do not use Veterans Health Administration (VHA) services), VHA doctors and staff, as well as other professionals who provide services to veterans.
Currently, up to 20% of women veterans have PTSD, and 55% of women veterans have experienced Military Sexual Trauma (MST)
Addressing Transportation to the Hospital
The team found that women veterans face challenges travelling to the hospital for several reasons. They may need to make numerous arrangements—including taking time off work, scheduling childcare, juggling school demands, and more. Oftentimes, this means that their personal health falls to the bottom of their list of priorities. “Women veterans always put their family first,” said one VHA administrator. “They prioritize their children or grandchildren over their doctor’s appointment.” The team also learned that many women veterans experience difficulties with mobility or mental health as resulting from their time in service.
“We were shocked to learn that currently, up to 20% of women veterans have PTSD, and that 55% of women veterans have experienced Military Sexual Trauma (MST)—a higher rate than ever before.” Alarmed by the statistics, the team looked to existing alternatives for private or semi-private transportation—finding the options to be either too expensive or overtly taxing on anyone with mental or physical trauma.
Determined to seek out an alternative, they reached out to representatives from the four rideshare companies with a presence in New York City: Uber, Lyft, Juno, and Via. They designed branded interfaces to propose different, viable methods by which each organization could support veterans.
The first design offering was a feature on veterans’ apps in which they could access discounted rides specifically originating from and arriving at the VA hospital. The team imagined that the rideshare company would absorb this cost, contingent upon on the number of veterans making use of the feature. The second, more sustainable alternative, was a feature that gave civilians the option of gifting rides to veterans, by being prompted to donate a few dollars at the end of their own trips.
The third proposal was to provide civilians the ability to purchase gift cards in public spaces such as coffee shops—which would then be sent to the VA hospital and given to veterans when making an appointment. The team is currently in communications with representatives from the rideshare organizations in hopes of taking the first option forward.
“I get screamed at every day walking in the building from the [male] vet who sells stuff outside. So there is this male culture that makes it really hard for female vets to come.”
Wayfinding within the Hospital
The women's clinic in the VHA has strived to create a safe and comfortable environment for women veterans. Unfortunately, this environment does not often extend past the clinic's walls. Women, especially those who have experienced MST, can be made to feel uncomfortable by some of their male peers.
The team felt strongly that this was an issue they wanted to tackle. But the deeper they looked, the more they realized that the challenge was beyond that of the in-hospital environment, and even beyond systemic military culture. “If we can’t change system or attitudes of male veterans, we want to at least guide women veterans to safe spaces, as quickly as possible,” argued designer Chris Rand. From there, the team arrived at a subtle system of strategically-placed ‘breadcrumbs’ leading to the 9th floor women’s clinic.
While marking this route, the team wanted to remain unobtrusive to the greater hospital landscape. They did this by making use of colors and symbols without the visual clutter of traditional signage. Here, the team leveraged strategic areas such as hallway corners and door handles—elements which are rarely used for obvious wayfinding. “We wanted to do as much as we could, while adding as little as possible,” said designer Kuan Xu. The final design included a series of acrylic corner guards and door knob hangers, easily installed, adjusted, and moved. These would provide subtle "bread-crumbing" signage to women vets visiting the VA hospital and trying to find their way to the clinic.
Another critical realization for the team was that the patient journey starts at home, once the woman veteran receives her appointment confirmation and details in the mail. As such, the team also redesigned the brochure that comes with her appointment package, both to introduce the symbology of the breadcrumbs, and to extend the personal, comfortable environment of the women’s clinic to the home.
Over and over again in their interviews, the team heard great stories about a specific doctor or staff member that turned a regular hospital experience into a something memorable.
Humanizing the Language of Pre-Appointment Communications
Lastly, the team looked to opportunities where they could humanize the language of pre-appointment communications with women veterans. Given the complex and highly-regulated environment of the veteran healthcare system, much of the print information available to patients was impersonal and difficult to parse. As such, the team hoped to re-evaluate these touch points—including the appointment reminder letters, and the doctor profiles section of the VHA website—seeking opportunities to integrate more precise and comprehensible language.
They began by researching existing examples of methods used by private clinics to correspond with their patients. Over and over again in their interviews, the team heard great stories about a specific doctor or staff member that turned a regular hospital experience into a something memorable. However, they came to a breakthrough moment after speaking to a woman veteran with several positive experiences at the VHA. She said, “I don’t really care if you have a professional profile for every one of these doctors. I just want some stories about who these people are! We need to inspire some confidence. There are great practitioners here.” From this, the team realized that they needed to emphasize the strengths and stories of the VHA’s dedicated doctors, administrators, and staff.
The team was able to create several prototypes, each illustrating the direction towards which the VHA could improve their methods of communication with patients. Despite an abundance of pre-appointment interactions the VHA had with patients—a reminder letter, an email, and a reminder phone call, as well as other online resources—there were few resources for patients to learn about their providers prior to an appointment. Even in situations where patients were able to learn more about their providers, the team heard that patients were often disappointed by the resources available to them.
It was important to the team that their final designs be implementable at little disruption and cost to the VHA. For this reason, the team integrated patient and physician stories into pre-appointment correspondences that were already being sent to women veterans.
The redesign featured photographs of staff members front and center—each accompanied by their personal story, philosophy, and testimonials from other veterans.
In the end, the team wanted to acknowledge that their interventions were small steps in the larger picture of women veterans’ health care experience. Throughout the fifteen-week project, they were exposed to an array of incredibly dedicated stakeholders, committed to giving back to the veteran community. “We came to a number of insights around staff turnover, and the appointment notification system that were beyond the scope of our project, but there are existing initiatives to improve upon them. We’re excited to see what’s to come!”