Insight

As a country, we’ve witnessed an erosion of trust in institutions that once served as the bedrock of our society. According to the American Customer Satisfaction Index, citizen satisfaction with U.S. federal government services dropped to an all-time low in 2021, declining to 63.4 on their 100-point scale. 

Misinformation, systemic racism, growing economic disparities, and shifting power dynamics have all undermined trust in government. Similarly, frustrating customer experiences with government services, like complex program requirements, long wait times, and arduous applications, have disillusioned many. The latter has become so pressing that President Biden issued an executive order in 2021 on “Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government.” 

All of this might seem hopeless, but at Nava, we believe that it means there’s opportunity ahead. We believe that human-centered design—a practice that focuses on those who use and need government services—is the crux of rebuilding trust in institutions. 

This belief guided several of our recent projects that have contributed to positive government experiences. Since the Commonwealth of Massachusetts tapped us to launch its first paid family and medical leave program (PFML) in Jan. 2021, the program has paid out $1 billion in benefits to people experiencing major life events. We helped build the U.S. Department of Veterans Affairs’ (VA) Rapid Ready for Decision pilot, which has saved Veterans over 10,000 days of waiting for disability benefits. And California’s Employment Development Department (EDD) selected us to help design a tool that gave unemployment insurance claimants critical status details amidst the explosion of claims during the pandemic.

As service designers, we approach these projects with a critical mindset. We look for the root of problems and we constantly question how we can improve our work and scale our successes. Most importantly, we approach our work with an eye toward what I like to call the plumbing of government—the civil servants who keep government processes running despite all kinds of challenges. Like the pipes and infrastructure that remain unseen but nonetheless supply us with water, civil servants work behind-the-scenes to provide us with essential public services. 

Difficulties like procurement, infrastructure, policy, workforce issues, and scarcity can affect government’s ability to meet the public’s needs. At Nava, we implement human-centered design to take on these challenges at all levels of government, including the experiences that happen behind-the-scenes. 

I interviewed five designers at Nava to learn about how human-centered design practices can contribute to backstage service improvement. If you're a designer, I hope these examples can illustrate how and why your work is important. If you're a government leader, I want to highlight how designers can fit into scenarios that might seem purely technical or purely policy-oriented, so that you can make space for designers on your teams. 

Designing for policy prototyping

Implementing policy within government is complex and often affects how the private sector operates. For instance, health care policy changes can impact the way a physician provides service to their patients. Since policy changes can lead to unanticipated challenges or benefits, it’s crucial for policy makers to understand how new requirements will fit into the day-to-day life of the public. One way to achieve this understanding is through prototyping, or building preliminary versions of a product that designers can learn from and iterate on. This is where service designers come in.

Momo Miyazaki is a designer/researcher at Nava who helped support the Centers for Medicare & Medicaid Services (CMS) on prototyping an Application Programming Interface (API)—technology that connects disparate, fractured systems. An API standard is a shared, well-defined format for accessing and interacting with data.

Momo’s team helped CMS implement details of the Fast Healthcare Interoperability Standard (FHIR). FHIR is a comprehensive framework for exchanging healthcare data between technology systems via the FHIR API. 

Momo’s team prototyped an interface for clinics to use the FHIR API to systematically collect demographic data and other key information about patients. Having access to this data helps CMS assess health equity and inform policy changes to improve the nation’s health.

Momo’s job was to show the API prototype and a questionnaire that would collect patient data to patients, medical providers, and administrative staff to gauge how it would affect their workflows. This informed potential consequences of CMS’s interoperability mandate that requires providers to use FHIR. 

Momo explained that prototypes aim to shed light on the real-world impacts of policy changes or new technology. Designers can do this by using prototypes to conduct qualitative research with participants that are representative of those impacted by policy. Prototyping can reveal unanticipated challenges, probe pain points, and answer clarifying questions. 

For example, Momo’s research demonstrated that data submission to CMS can be time and labor-intensive for clinics, and that any change to a provider’s data submission process could stretch their already limited resources. As a result, Momo suggested that it would be helpful to implement resources and incentives in the data submission process. CMS has the unique opportunity to give practices national insights on healthcare data that is not available in a single provider’s EMR. Equipping providers with these insights would make it more rewarding for them to submit patient data to CMS. 

“If you have bigger, systemic realizations that are beyond your scope, document them. Give stakeholders the info they need to make the best decisions possible,” Momo says.

Government agencies working on policy prototyping should collaborate with researchers to identify and prioritize action items that emerge. Government officials can support designers by creating ways to document findings and by remaining open to new learnings. 

Designing for the developer experience

Designing for the developer experience (DevEx) means improving the productivity of engineers by removing obstacles or providing resources that allow them to focus on mission-oriented work. In DevEx work, we apply human-centered design and user experience (UX) best practices to developer-focused processes and tools.

Though DevEx is still an emerging focus for design, there’s a huge opportunity to help government modernization efforts. Nava employs designer/researchers who focus on DevEx to support this problem space. Norah Leibow is such a designer/researcher at Nava working in our Federal Health portfolio. I spoke with Norah about her work as part of a Platform Team with the Centers for Medicare & Medicaid Services (CMS) Medicare Payment System Modernization (MPSM) program. Norah’s team is helping CMS modernize its payment system by moving the system’s capabilities from traditional mainframe storage to the cloud. 

Norah told me that like all good design, improving the developer experience starts with understanding users and their contexts. When your users are technically adept, this means becoming conversant in their tools, technology, and concepts so that you can meet them where they are. It’s important to understand the full value and potential of your offering, the effort involved in operating it, and the universe of support that comes with it. Designers can gain this contextual awareness through user interviews, workshops, and literature review. 

For government officials who employ DevEx designers, Norah said it’s important to enforce a user-centered approach across the project or program. Government officials should ask questions like, “Where are developer roadblocks? Where do their biggest headaches come from? Are they getting the support they need?” This allows designers to help the team understand their users and ultimately see better outcomes. 

Designing for enterprise operations

Enterprise operations encompass everything from the services an agency offers to the people it employs to the service’s end users. Designers are important to enterprise operations because they can foster a learning environment that encourages ongoing improvements to an organization incrementally, or continuous improvement. I spoke with Stefanie Owens, a senior designer/researcher and design manager at Nava, about her work on a cloud enterprise operations project with CMS. 

Stefanie said that in enterprise projects, there’s often a broad distribution of duties across multiple teams. For example, one team might develop a new service while another team operates it. Designers conduct research across people, teams, processes, and tools to gain a holistic understanding of systems and uncover organizational challenges. 

Stefanie said her team employed a variety of quantitative and qualitative research methods to learn the ins-and-outs of CMS’s cloud operations. This helped them gauge how satisfied people are with CMS’s services and to understand CMS’s business needs. Stefanie pointed out that it’s important for designers to work closely with stakeholders and product leadership in order to exchange insights and support long-term development. Once designers have synthesized input from stakeholders, they can prioritize removing roadblocks. 

“Human-centered design often helps stakeholders align because designers ask critical questions and force people to look at a space differently,” Stefanie says.

In order to ensure successful enterprise operations, it’s crucial for government agencies to give designers access to the people and teams they need. This can help designers understand an agency’s broader strategy and share their insights with key stakeholders.

Designing for technical assessments

Large-scale technical assessments can investigate full portfolios or systems across an organization. Such assessments—which might be proactive or in response to an event—can help leadership set roadmaps and prepare budgets or investments. When conducting large-scale technical assessments, it’s important to include designers who bring an analytical perspective.

Mallory Young is a design/researcher at Nava who recently worked with the State of California to proactively complete technical assessments of various state-wide tools and systems. She said that designers can operate at different levels on a project like this, though the most straight-forward way to involve designers is in the actual assessment of a system. Designers performing a technical assessment might ensure that the team is recruiting the right people for user research and following interview best practices. Designers can then help identify meaningful takeaways and synthesize them into actionable recommendations.

At a higher level, designers can implement DesignOps methods—creating templates and facilitating process refinement—that streamline user research. At the highest level, designers might collaborate with program leadership to ensure that the technical assessment strategically aligns with program needs and that it yields actionable insights.

In some contexts, research expertise may be seen as secondary to engineering expertise. But in order to produce the best outcomes, designers and technical experts should work together.

“When working within a very technical space, it’s easy to think design is just soft skills. But designers’ research expertise can help ensure that your team is getting the answers you need efficiently,” Mallory says. 

Designing for demonstration projects

Demonstration projects, or an experimental program created to demonstrate the feasibility of new methods or types of services, focus on innovation and learning rather than creating production-ready products. They often entail a variety of design and research methods to form a hypothesis and build solutions. This all occurs in a low-risk environment and allows teams to identify and de-risk future investments.

In demonstration projects, designers may collaborate with stakeholders and future users to build prototypes that meet users’ needs. Design best practices and sound research methods ensure that the project centers on the desired learnings, while clear documentation and presentations help others understand lessons learned. 

I spoke with Daniella DeVera, a senior designer/researcher and design manager at Nava, about a demonstration project she’s been working on with Montana WIC. Daniella’s team has been building an eligibility screener and API prototype that can help catalyze the modernization of Montana WIC and inform opportunities to improve and scale the program nationally. Daniella explained that a successful demonstration project yields focused learnings that inform future decisions. 

The first phase of a demonstration project, Daniella said, is initial discovery. During this phase, designers gain contextual understanding and develop a hypothesis through research and interviews. Next, designers create a prototype that works toward validating their hypothesis. It’s important that such a prototype aligns with the team’s learning goals and that it’s evaluated through concept and usability testing. Finally, designers will leverage design to share their findings with stakeholders. 

“When the core focus of a project is learning and forming an opinion, you as a designer bring strengths and you need to play those strengths off of your cross-functional collaborators,” Daniella says. This means that designers should collaborate with teammates in more technical roles like engineering. Ensuring that teams are balanced with diverse skills allows a demonstration project to yield more comprehensive learnings.

Employing design to build successful government services

A few motifs arose across my conversations with these designers. First, designing for a backstage technical service improvement can be a more ambiguous experience than designing a product or user experience. The designers I spoke to said that teammates can help navigate this ambiguity by acting as a sounding board. Second, designing for backstage government experiences can feel unseen, but it’s still incredibly important to building strong institutional foundations. When struggling with this, it’s helpful for designers to define baselines within their realm of influence and return to them frequently. 

I’d also like to make a few suggestions for government leaders who wish to help designers succeed in projects like the ones I’ve highlighted:

• Help your team understand that you value design expertise. Make it clear that designers can help meet your program’s goals and users’ needs. 

• Know that design without implementation is just theory. Closely integrate your design and product management teams and create feedback loops that turn user needs into roadmaps.

• Connect to the big picture. Help your teams understand how their work contributes to better public outcomes. This might mean illustrating how a cloud platform helps replace a legacy system to improve service delivery, or how a data API allows public health officials to track emerging outbreaks. 

• Remember that trust is built by responding to people’s needs over and over in a variety of contexts. 

Designers working on these types of projects are improving the plumbing of government. If your faucet doesn’t connect to pipes that connect to a water main that’s connected to a water treatment facility that’s connected to the reservoir that’s fed by a watershed, then nothing good is going to come out of your faucet and you’ll remain thirsty. 

It’s the same with government. Paying attention to the behind-the-scenes aspects of government is just as important as creating good customer experiences that build trust. In fact, it’s the behind-the-scenes work that contributes to better experiences with government. 

This article was adapted from Ed Mullen's session at Rosenfeld Media's Civic Design conference.