The instructions were a little vague. It was clear that I needed to turn in the signed form at Town Hall, and so I entered the maze of corridors and staircases in an attempt to find the office that I needed. From the second to the fourth and back to the first floor, I ran into a number of people who said, “No, this isn’t the right place. You have to go to this office” Finally, through the washing machine of being passed from place to place, I turned in the form at the correct office– or at least I think I did.
Similarly, I recent attempted to schedule a simple doctor’s appointment. I called the number and was asked to select from a long list of prompts. Unfortunately, by the way, the first prompts were — if you’re a doctor, press “1”, if you’re a pharmacist, press “2” — a clear message that I was not the most important customer that might be calling this linle. Finally, after listening to all the options, identifying myself as a patient, avoiding the impulse to push too early (No! I don’t want to refill my medication)– you hopefully get to the right person to conduct the transaction that you want. But, god forbid you make a mistake and get the “That’s not my department, let me forward you to”– and you’re left to explain the reason for your call all over again to a new person who may or may not be able to help you.
Okay. Rant Over. This is something that we have all experienced from time to time and while some settings have dramatically changed the way they create access, too many are still stuck in the “Press 8 for” world.
Unfortunately, this is more than just a pet peeve and frustration for you and I. For lower-income individuals, tt can be the difference between someone getting the services that they need or not. In working with those who need help, sometimes the biggest barrier is not the availability of help, but the process by which assistance can be accessed. If I need to get signed up for healthcare and food assistance for example, I may have to go to two (or more) different sites, fill out two sets of paperwork (that mostly ask for the same information) and bring verification documents that may be slightly different for each place. No one wants to be passed around like a late-addition prompt on an automated answering service– and nowhere do we have system more like that than in our support services for social and health needs.
This obstacle course to get access to services is challenging for any person, let alone if you are socioeconomically or emotionally distressed. It is complicated even further if you are linguistically or culturally isolated. It’s darn near impossible if you’re working multiple jobs, lack consistent transportation or have any of dozens of other challenges that increase the size of the barriers between you and what you need.
That is why I am so thrilled with a concept that is beginning to grow called “No wrong door” (NWD). NWD is a person-centered approach that streamlines access to the resources that are available to the person. Originally built as a collaborative enterprise between the Administration for Community Living, the Centers for Medicare & Medicaid Services and the Veterans Health Administration, this government program worked to build better access to those requiring long-term services and support (LTSS). The concept has since expanded to other places that are using technology to unify resources like NY Connects.
The private sector is getting involved in this work as well. Take Single Stop. By providing a unified application form/process, they are streamlining access to a variety of resources, not sending individuals to multiple offices to get the things that they need. According to the Single Stop website, they have already served 1 million households in 9 states with a $20 to $1 return on investment. Other systems are beginning to take this promising approach including central intake systems for needs like housing assistance.
What do these approaches teach us and how can we build upon them?
Be person-centered. Just like my call to the doctor’s office, systems need to be designed for the people they are made to serve. This sounds like it should be obvious, but it is not standard practice. Instead our systems get designed for any number of reasons– to make it easiest for staff, to comply with the requirements of a funding source, or because we’ve always done it this way– If our services are centered on anything other than the person being served, we have missed the boat and will design systems that work for other purposes. Design thinking is a very useful tool here. Built out of the Stanford d school (Recommended Read: Change by Design), this framework grounds our innovation in the experience of the person. The first (and regularly-repeated step — as this is an iterative process) is empathy– developing an understanding for the processes that people face, including the problems and barriers that make accessing a service more difficult.
Over the years, I participated in so many meetings where organizational leaders talk about the experience of people. We hypothesize (though often with an assumption that we know the answer) the reasons why families use the emergency department frequently, why people don’t purchase fruits and vegetables, etc.). Yet despite the best intentions (sometimes), rarely are the actual people consulted. If we want to design person-centered systems, it must begin by actually interacting with the person–becoming a client.
If you ever have a chance to put yourself in the shoes of another, do it– even if it’s simulated. My friends at Pathways to Prosperity (and others out there) lead events called “Poverty Simulations”, where people (often professionals serving a low-income population either directly or indirectly) have the opportunity experience a small, simulated taste of what it is like to navigate the social service system. Participating in one of these events was an incredibly powerful experience because you see so clearly how “wrong doors” are slammed in faces all the time. You can sense the frustration of trying your best, but being thwarted by a system that wasn’t designed for you. If we want to really make an impact, we have to begin with the experience of the person in mind
Cut out the silos. One of the biggest drivers of “wrong door” thinking are what often get described as “silos”. These isolated structures may represent different organizations, different sectors or even programs or initiatives within a sector. Most of our organizations run within a certain framework that was developed based on their traditions, regulatory requirements, or leadership design. Even the best-designed system within a sector, let’s say healthcare– may create a barrier between another– say housing assistance.
Much has been written about collective impact approaches– about getting organizations to identify a common agenda, to bring their own expertise and contribution to the table and to create greater capacity by uniting these efforts. This is absolutely essential for a no wrong door approach. Organizations have to be willing to change the way they interact with the people they serve and the other stakeholders. We can build a better network of resources that work together in a mutually-reinforcing way that support real change. This should include some of the unusual suspects as well– bringing business partners, town planners, etc. to the table– each with something to contribute to designing a better experience.
What about my door?
Finally, I want to write a bit not about organizational capacity or program design, but how this concept of No Wrong Door might apply to our roles as neighbors and community change agents. In one organization I worked in, we often had difficulty with people finding their way through our facility. A great deal of time and energy was spent in thinking about better signage, maps or even technologies to help people navigate through the buildings. But one of the most powerful interventions was much more simple. All of the leaders were encouraged to keep an eye out for a person who may look a little lost and simply do two things: 1) Ask “Can I help you find something?” and 2) after the person indicated where they were going to say “Let me take you there”. The simple, but powerful idea was that no matter who you were– a janitor or an executive– you could stop what you were doing to help the customer get to where they needed to be. This is no wrong door at its best. It doesn’t say– “this isn’t my job”– but says that whoever I happen upon I will take it on as my responsibility to get them where they need to be.
That works in organizations and I think it can work in our day to day interactions. Instead of saying “I don’t know” or putting your head down and minding your own business, can we go the extra mile and help folks get to where they need to go? Can we notice and empathize with the needs of our neighbors and those on the margins of our community? Can we help bridge connections that others may not have access to? Can we take every figurative knock on our door as an opportunity to build the beloved community one moment at a time?
I believe we can. Call it serendipity or karma or god’s will, but I’d challenge you to think that your door (literally or figuratively) is never the wrong one for someone in need.
Please share your ideas, questions, and comments below. Let’s think about how we can make sure there are no wrong doors in our communities.