Design is shaping the world. Many examples illustrate that designers can change the world for the better. We are entrusted with more and more complex challenges and develop ever-novel approaches. Nowadays a plethora of design discipline exists and it seems fitting to clarify what it is that unites the designers today to then discuss how we can connect design to other fields better in order to maximise the impact of our work. One field that is proving a particularly rich complement to design is Systems Thinking, which essentially studying the interdependencies between elements in complex structures. While design thinking is a bottom up approach, systems thinking can supply the big picture context. Combining the two allows us to be more targeted in how we apply our design efforts.

1. Inspired by people‚ designed for impact.
Moving beyond lucky –
design thinking and systems thinking

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portrait of grandma soboll

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We’re taming the increasing
complexity of today’s world with
the timeless simplicity of good
design.

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Design Thinking
Design-driven Innovation
Experience Design
Digital Design
Industrial Design
Service Design
What is it that you actually do?

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Design Thinking
Design-driven Innovation
Experience Design
Digital Design
Industrial Design
Service Design
Systems Thinking
What is it that you actually do?

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Design Thinking
Design-driven Innovation
Experience Design
Digital Design
Industrial Design
Service Design
Systems Thinking
What is it that you actually do?

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2 Projects

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Brief: “How might we fight child obesity by
getting kids to move more?”

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UNICEF Kid Power
Giving kids the power to save lives

10. Daylight Confidential
UNICEF Kid Power
Giving kids the power to save lives

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Challenges are becoming ever
more complex and intractable

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Brief: “How might we make Obamacare viable?”

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The Problem

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Users are a crucial piece of the puzzle – one of many.
Centric.
Member shows signs of being at
risk and is impactable.
PROVIDER REFERRAL
Medical, behavioral, or social
provider identifies potential high
utilizer.
Creates and maintains a system
Centric members.
Number of ED visits, inmember stays and
claims dollars compared to averages.
History of referrals to Centric; notes and
information relevant to assessment of
membership.
Member interacts with various social
services like food bank and housing
shelters.
SOCIAL SERVICES REFERRAL
Social service flag members based on
their frequency of utilization and
Centric qualifying criteria.
Collaborates with social services
to target members at crucial
points of contact.
moments that make up the Centric experience. While
some of these are sequential and are denoted by
arrows, not all members will experience each moment.
Look below for details on how to read each box.
Member travels, or is driven, to the
Centric, and meets with providers on
the care team. Member works with the
Centric experience.
CENTRIC WELCOME
The Advocate drives the member to
Centric, or they meet at the entrance,
and takes the member to his/her 45
minute appointment. In the
appointment they are joined by the
TESTABLE MOMENT
MEMBER ACTION
PROVIDER ACTION
MEMBER ABILITY TO
TAKE DECISION
COLORS DENOTE
Assess
membe
CENTRIC
MEDI
CAL BE
H
AVIORAL
SOCIAL

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But we need to know more to move beyond lucky

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Three key benefits of
systems thinking

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1. Gain holistic view,
understand patterns
(system)

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INSUFFICIENT
HOUSING FOR LOW
INCOME
LACK OF SOCIAL
CAPITAL/STANDING
AMONG POOR
BAD HABITS
COMPOUNDING
FINANCIAL PROBLEMS
NOT ENOUGH JOB
OPPORTUNITIES
LOW COST FOOD
LEADS TO POOR
NUTRITION
RELUCTANCE ( ESP.OF
IMMIGRANTS) TO
ENGAGE WITH
GOVERNMENT
AGENCIES
NOT ENOUGH TRADE
EDUCATION
OPPORTUNITIES THAT
ALIGN WITH LOCAL
ECONOMY
POVERTY PREVENTS
LONG-TERM FOCUS IN
PRIORITIES
HIGH RATES OF
BEHAVIORAL ISSUES,
INCL. DRUG ABUSE
HOMELESSNESS
CREATES SOCIAL
STIGMA
MISTRUST O
GOVERNME
REPRESENTAT
DON’T FEEL LIKE
VALUED PART OF
SOCIETY
CHRONIC DISEASES
SPREAD AND GO
UNTREATED FOR TOO
LONG
LACK OF ADDRESS
PREVENTS USERS
FROM ENGAGING WITH
VITAL SERVICES
BAD CREDIT
HISTORY
VENTS USERS
OM RENTING A
HOME
UNSTABLE FAMILY
DYNAMICS LEAD TO
PSYCHOLOGICAL
PROBLEMS
1. Gain holistic view,
understand patterns
(interconnectedness)

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No housing
No address
Debt
Frequent acute health issues,
visits to the emergency room
Underemployed
No relationship with
primary care physician
No steady job due to
unstable health Don’t get reminders about
preventative health measures
Causality Loops
e.g. around determinants of health
Causality Loops
Missed medical appointments
No credit

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No housing
No address
Debt
Frequent acute health issues,
visits to the emergency room
Underemployed
No relationship with
primary care physician
No steady job due to
unstable health Don’t get reminders about
preventative health measures
Causality Loops
Missed medical appointments
No credit

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No housing
No address
Debt
Frequent acute health issues,
visits to the emergency room
Underemployed
No relationship with
primary care physician
No steady job due to
unstable health Don’t get reminders about
preventative health measures
Causality Loops
Missed medical appointments
No credit
2. Find points
of leverage

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No housing
No address
Debt
Frequent acute health issues,
visits to the emergency room
Underemployed
No relationship with
primary care physician
No steady job due to
unstable health Don’t get reminders about
preventative health measures
Missed medical appointments
Causality Loops
3. Track impact
step-by-step
No credit
2. Find points
of leverage

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1. Understand patterns
2. Find points of leverage
3. Track impact step-by-step

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Is systems thinking the new
design thinking?
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Dealing with complex challenges
Trusting in process
Iterative
COMMONALITIES
Systems Thinking and Design Thinking

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geared towards action
optimistic, generative
user perspective
bottom up
tangible, nuanced, granular
analytical
neutral, modelling
expert perspective
top down
abstract, theoretical
Design Thinking Systems Thinking
Systems Thinking and Design Thinking
DIFFERENCES

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Combining both
Define opportunity
Create Solutions
Track Impact
Iterate
Design
Thinking
Systems
Thinking

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Member visits the ED for an
emergent/non emergent need.
ED/HOSPITAL REFERRAL
Ongoing- All year around Up to 3 months 12-24 months
ED/Hospital flags the member as an
appropriate candidate for Centric.
Coordinates with ED/Hospital and
collects data on the member.
History of referrals to Centric; notes and history
relevant to assessment of membership.
Member’s medical utilization increases
or shows patterns of high utilization.
UTILIZATION PATTERNS
Change of patterns identifies member
as candidate for Centric.
Tracks member’s medical utilization;
develops and assesses criteria for
most strategic high utilizer to invite to
Centric.
Member shows signs of being at
risk and is impactable.
PROVIDER REFERRAL
Medical, behavioral, or social
provider identifies potential high
utilizer.
Creates and maintains a system
Centric members.
Number of ED visits, inmember stays and
claims dollars compared to averages.
CONNECT COLLABORATEIDENTIFY GRADUATE
Member travels, or is driven, to Centric
and meets with providers on the care
team. Member expresses personal
needs/wants and works with the care
Centric experience.
CENTRIC WELCOME
The Advocate accompanies the
member on the drive to Centric (or
they meet at the entrance) and takes
member to their first meeting with the
PCP/behaviorist or any other Centric
provider based on the need. In mutual
agreement, they create an integrated
care plan, schedule of home and
Centric visits, and ways to measure
progress both for member and
provider (including app and
monitoring tools).
Admin assigns/assembles individual
providers of care team to member and
schedules in-person meeting of care
team.
Centric resources & Centric Dashboard
Informed by member’s history, Centric team records
assessment and identifies specific metrics for
measuring progress.
History of referrals to Centric; notes and
information relevant to assessment of
membership.
Member interacts with various social
services like food bank and housing
shelters.
SOCIAL SERVICES REFERRAL
Social service flag members based on
their frequency of utilization and
Centric qualifying criteria.
Collaborates with social services
to target members at crucial
points of contact.
History of members’ social services utilization and
perceived needs.
Member calls 911 for non urgent needs
frequently.
EMS EARLY WARNING SYSTEM
EMS assesses cases that are non
emergent, de-escalates issues and
notifies Centric of potential members.
Collaborates with EMS to gather
information about the member
Member visits Centric outside of
appointments for enriching, empowering,
and community-building events.
CENTRIC RESOURCES & EVENTS
Providers create and participate in
events in their areas of expertise and
passion.
Determines and organizes educational
events, gatherings, and resources.
With support from the Advocate,
member makes an appointment in
advance and arrives, potentially with the
help of Centric transport, to the
appointment.
IN-CLINIC APPOINTMENT
Centric providers provide health
check ups and attend to health needs.
Centric.
Member utilizes Centric app to check in
with Advocate and monitor progress on
health goals. Member receives rewards
to achieving health goals.
MONITORING AND CARE
MANAGEMENT
Care team, and especially Advocate,
checks in with member and monitors
health. Provides support, motivation,
celebrates milestones and encourages
independence along the way.
Keeps the appointment calendar
Centric Dashboard & App
Measurement of progress on specific health
conditions and goals (e.g. remote monitoring of
blood sugar through a member’s use of glucometer).
Members are able to make same-day
appointments.
SAME DAY APPOINTMENT
Open-access scheduling preserves a
window of providers’ time for
same-day appointments.
Regulates open-access scheduling in
response to member’s needs.
Member needs specialty care that spans
the medical, behavioral and social
realms.
SPECIALTY INPATIENT &
OUTPATIENTCARE
The care team revises care plan and
reaches out to specialty partners.
Advocate helps schedule
appointments and supports the
member through the care process
outside of Centric.
EMR is shared between Centric,
specialist, and hospital.
Member experiences sudden or ongoing
need for social services such as housing,
food, utilities etc.
CONNECT TO SOCIAL SERVICES
Advocate assesses needs for social
services. Harnesses Centric’s financial
planner/home & community planner,
housing services and others to
address and follow up on social needs.
work for state services.
Centric Dashboard
Centric Dashboard
CENTRIC SERVICE
EXPERIENCE MAP
Centric keeps the member at the center of care,
supporting the whole patient for long-term health.
- Creates an interdisciplinary team around each patient
to address social, behavioral, and medical issues;
support the whole patient and promote long-term
health.
- Assigns each member a Personal Advocate to
integrate care services provided by the interdisciplinary
team, help members keep appointments, support
healthy behavior, and address issues before they
become critical.
- Meets members where they are, using a combination
of home visits, advanced technology, and a central
headquarters for basic care.
- Provides residence-based support that offers a
lifeboat out of the hospital and into a more sustainable
way of living.
This document describes some of the discrete
moments that make up the Centric experience. While
some of these are sequential and are denoted by
arrows, not all members will experience each moment.
Look below for details on how to read each box.
Member travels, or is driven, to the
Centric, and meets with providers on
the care team. Member works with the
Centric experience.
CENTRIC WELCOME
The Advocate drives the member to
Centric, or they meet at the entrance,
and takes the member to his/her 45
minute appointment. In the
appointment they are joined by the
PCP, RN, behavioral health ARNP, and
any other Centric staff requested in the
initial assessment. They agree on a
integrated care plan, schedule of home
and clinic visits, and assessment
strategy.
Admin assigns/assembles individual
providers of care team to member.
Schedules in-person meeting of care
team.
Care team roster & Centric OS
Informed by member’s history, Centric team records
assessment and makes available to the care team.
TOOL
TESTABLE MOMENT
MEMBER ACTION
PROVIDER ACTION
BACK OFFICE ACTION
DATA CAPTURED AND
METRICS OF SUCCESS
MEMBER ABILITY TO
TAKE DECISION
COLORS DENOTE
WHICH PART OF THE
CENTRIC IS ACTIVE
IDENTIFY AS CENTRIC
CANDIDATE
Staff medical director and care team
have a weekly meeting to evaluate
whether identified Centric candidates
are to be invited to become
members.
Centric Criteria
Centric Criteria
Preliminary assessment of candidate
as vulnerable and impactable.
Assess against criteria for most strategic
members to invite to Centric.
Member is available and present for the
appointment.
AT HOME APPOINTMENTS
Advocate, NP, PCP and other care
team members meet member at home,
equipped with portable medical
equipment. Appointments of less
complexity are facilitated by the
Advocate through telehealth.
Manage the back end systems for
making in-home and virtual tele-health
appointments possible.
Centric Dashboard & Telehealth
Member may be present and expresses
personal needs and wants.
CARE CONFERENCE
Care team providers meet bi-weekly
to discuss progress from a medical,
behavioral, and social lens.
Aggregate and provide data on health
progress.
Centric Integrated EMR
Because of the tendency for high
utilizers to relapse, we expect most
Centric members will always be Centric
members. But as the number of
touches drops over time members may
"graduate" by being invited to give
back to the Centric community, thus
becoming members and participants.
GRADUATION
Advocate continues regular - but less
frequent - check-ins and makes sure
the member feels connected to
Centric.
Continues to manage strategic
communication of member's health
and social determinants progress
while also creating opportunities for
member involvement in Centric, such
as assisting new members, offering
peer counseling, etc.
Detailed and at-a-glance take on member’s
progress at Centric.
Member calls the 24x7 Centric number
anytime between 8pm and 7am.
24/7 CENTRIC
Centric provides 24/7 nurse
phone/video-line to triage various needs.
The nurse attempts to de-escalate issue,
connects to care team and schedules
appointments for the next morning if
necessary. Community EMT’s fill in for
the Advocates during after hours.
Centric App
Capture and prepare pareto analysis
of needs and answers. Channels
Centric members’ calls from EMT and
ED during afterhours.
CENTRIC
MEDI
CAL BE
H
AVIORAL
SOCIAL
Member gets to know the Advocate
and Centric better.
Advocate reaches out to the member
and tries to build a trusting relationship
by understanding their unique situation
and needs and offering some help.
TRUST BUILDING
INVITATION TO ENGAGE
Member receives an invitation to join
Centric. Member accepts or refuses.
Advocate descibes the value of Centric
for the member and invites them to be
a part of Centric. Advocate also
requests signature for release from the
member.
Upon acceptance of the invitation,
member account is created in Centric
EMR and health history is aggregated.
Member agrees to a visit from the
Advocate and Registered Nurse.
HOME CONNECTION
Advocate and Registered Nurse visit
member’s home. They listen, understand
and assess members social, behavioral,
and medical needs; they then schedule
an appointment with specific providers
at Centric. Advocate also schedules
transportation and introduces the
Centric app for easy connectivity.
Routes medical history to Centric and
makes available to Advocate and
Registered Nurse. After home visit,
Advocate’s and Registered Nurse’s
assessments are added to member page.
Informed by member’s history, Advocate
interactions, Centric team records assessment and
makes available to the rest of the care team .
Centric tools

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31. Pilot launching next week.
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32. Inspired by people‚ designed for impact.
SYST E M S
P R AC T I C E
Handbook of Systems Thinking (Social Innovation)
www.daylightdesign.com/news
pascal@daylightdesign.com