How a new design process helps communities create their own health programs

It would seem that, by definition, social services and community health programs help the neighborhoods where they operate.

But talk to community leaders on the ground, like Adair Mosley, CEO of Pillsbury United Communities in Minneapolis, and it becomes clear that while intent isn’t lacking, designing services that really reflect community need is a challenge.

“Typically, social service is prescriptive in nature, anchored in hubris,” says Mosley, whose group serves underestimated populations across the city. “If it’s funder- or legislatively driven, a service rarely gets to the heart of the problem. It’s about asking the right questions, and in social services, we often have the wrong answer, since we’re not listening.”

By putting human-centered design practices at the center of a new way of creating local programs and initiatives, a wide-ranging pilot project wants to change how communities design their own future. An nationwide effort funded by the Robert Wood Johnson Foundation that kicked off this past fall, Raising Places is giving six different communities $60,000 each, to help develop programs that support healthy childhoods.

This initiative differs from the nonprofit’s usual programming focus due to its process. Utilizing an engagement program designed by Chicago-based Greater Good Studio, a socially oriented design practice, community feedback doesn’t start with solutions, but with understanding problems.

Consisting of a series of labs, prototyping sessions, and community discussions, the nine-month process is predicated on the idea that better understanding, involvement, and, ultimately, design—led by the community, not experts—creates lasting, effective solutions.

Reflecting a larger change in the health community that recognizes the how health and community development are intertwined—that your zip code can play as big or bigger a role than your genetic code—Raising Places takes the next logical step and asks the community to diagnose its own challenges.

In August, Raising Places chose six groups from a pool of 156 interested community organizations: Mosley’s group in North Minneapolis, Minnesota; Bighorn Valley Health Center on the Crow Reservation in southeast Montana; Greater Hudson Promise Neighborhood in Hudson, New York; The Health Foundation in rural North Wilkesboro, North Carolina; South of Market Community Action Network (SOMCAN) in San Francisco; and SBCC, Thrive LA in Wilmington, a community near the ports of the Los Angeles harbor.

While the circumstances and areas of focus, ranging from healthy food access to police-community interaction and air quality, differ between groups, all said the curriculum laid out by Greater Good has led to deeper insights.

Greater Good’s idea grows out of its experience with nonprofits, local governments, and what it calls mission-driven organizations. Grants for these tend to be proscriptive, and while it’s great when a non-profit gets money to pursue a project or program that’s a perfect fit, often, community end up adjusting their programs to fit with funding guidelines, stifling innovation.

“Designers have a unique amount of power, but we’re often unaware,” says Sara Cantor Aye, co-founder of the studio with her husband, George. “We’re trying to share that power as much as we can.”

The Ayes proposed a different way of delivering solutions: start with a better understanding of the problem, to eventually end up with a better solution. The Raising Places program and grant offers communities the luxury of time and an ability to discuss and debate what they need best and enact a program based on community wisdom, not outsider observations.

Each community has a convener, a local service agency that facilitates the events, or labs, and a design team made up of other organizations and local leaders. Groups began with a kick-off lab that brought the team together to focus on areas of research, which then led to weeks of observation, emersion, and discussion of root causes and framing goals. Next, an ideas lab helped groups synthesize findings, brainstorm, and create prototypes.

Finally, after local teams finish the 12 weeks of prototyping and iteration they’re currently engaged in, they’ll hold the action lab in February, when they’ll examine and evaluate prototypes, and figure out a plan to move forward. Throughout the entire process, Greater Good Studio offers technical assistance and guidance.

“We are intentional about not prescribing what needs to come out of the process,” said Katie Wehr, Senior Program Officer at the Robert Wood Johnson Foundation. “By funding a process, rather than a specific intervention, we enable the outcomes to be shaped, and ultimately owned, by the people living and working in each community.”

While many of the community leaders involved have already used some variation of human-centered design, or design thinking, in their work, they’ve found value in the Raising Places process.

Colleen Mooney, executive director of SBCC, Thrive LA, the convening organization working in Los Angeles, has always made common sense community engagement a part of her process. A 42-year veteran of the group, who has herself raised children while on welfare, she has a more personal connection to the organization’s mission, helping residents gain economic stability. She finds the lab process, especially reviewing prototypes, has given Thrive the tools to do what they’re already doing, just better and more in-depth.

“We didn’t really get concrete with residents, and they didn’t have the ability to think deeply about how best to invest their time and money,” she says. “The core value in human-centered design is having an open mind, and being willing to have other people say your idea sucks. That’s important.”

In North Wilkesboro, North Carolina, the Health Foundation has spent decades focused on improving rural health, helping to fund helipads for remote hospitals and expanding dialysis treatments. According to executive director Heather Murphy, the foundation has long believed “health was more than a visit to the doctor’s office,” zeroing-in on social determinants to wellbeing and how to make lasting improvements. Child obesity, a problem with interrelated causes, has long been a focus. The Raising Places grant has enabled the group to do a better job at getting more voices involved in the discussion.

“People can be architects of their own solutions, if only they’re invited to the table,” she says. “We understood that not everyone who needed to be at the table was at the table, and that people had strong opinions and ownership of the community, wanted to be a part of the solution, but didn’t know how.”

That sense of empowerment rings especially true for marginalized or ignored groups.

Dr. Megkian Doyle, of the Bighorn Valley Health Center in southeastern Montana, an organization that serves a large Native American population, says that the community has been “over-surveyed and over questioned,” left with the feeling that they’ve given information with little action or change in return. Raising Places has helped them expand their community outreach, leading to more long-term relationships and hard, but necessary conversations.

“It allowed us to listen to people that usually don’t get listened to,” Doyle says. “Usually with Native American communities, people go ask the elders. We also went to regular parents, people who were using drugs, and asked them about subjects they hadn’t been asked about before.”

Recently, the Raising Places team in Montana created a yard sign with the silhouette of people raising a teepee that they use to promote events and activities. The idea, says, Doyle, is wanting people to see that everyone is doing this together.

As the Raising Places enters the final stage, testing the ideas before turning the research into concrete ideas, conveners have expressed optimism about the outcomes. Mosley says the North Minneapolis community is currently evaluating more than a dozen concepts and has heard from hundreds of neighbors throughout the process. Whatever comes to life will be representative of North Minneapolis, he believes.

“Rarely do we have a funder that’ll fund the process,” he says. “That’s what’s so exciting about this body of work. It’s funding an equitable solution for the community, and it saves money by starting to meet the needs the community wants met.”

After all six groups hold their last meeting, the Robert Wood Johnson Foundation will host a national convening in April, gathering the organizations and policy and philanthropy experts to glean lessons from the program.

Mooney from Los Angeles said she’s interested in seeing if this part of the process helps the groups connect with funders who can help them continue their work, so Raising Places can both sustain the work it’s started while fine-tuning a better model of community engagement.

Heather Murphy from Wilkesboro hopes Raising Places can show other communities a better way to design their own better future.

“Product designers discovered a long time ago that you could give a product to someone, they’d tell you what they do and don’t like about it, and you could make it better,” she says. “Why should the systems in our communities, that ones take care of our kids and our families be any different?”