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Changing the Care Paradigm: Focusing on Resilient Family Development

The Center for the Urban Child and Healthy Family, within the Department of Pediatrics at Boston Medical Center, is building the Pediatric Practice of the Future that will ensure all children are healthy and ready to learn by age five. Over the course of the last nine months, the Center has undergone a Human Centered Design (HCD) process in partnership with Agncy, a local firm specializing in HCD. The aim has been to design the core components of the Pediatric Practice of the Future model. This work has been divided into two phases: first, an ethnographic exploration of families’ health priorities and second, a co-creation of the new model. Both phases involved BMC families and members of the Department of Pediatrics.

During the first phase, Agncy interviewed families from the pediatric primary care practice. Families were interviewed in their homes with a goal of understanding their definitions of health and wellness and to seek guidance on how to most effectively address their needs. Agncy also spent time in the pediatric clinic interviewing providers and staff as well as observing the clinic flow. This generative learning process set out to frame the opportunities for innovation from the perspective of families and members of the care team. At the conclusion of this phase, Agncy analyzed the information they gathered and abstracted key themes and insights. For example, all parents cited physical health in their definitions of “wellness”, with the majority also saying spiritual wellness was critical to their conception of health. Additionally, food and money were two key themes in almost every interview, indicating parent values. Through these two topics, Agncy was able to understand what parents find most important (and often lack) in their lives and experiences. Namely these were control, autonomy and choice, tangible feedback and clarity or comprehensibility. These insights served as the guideposts for the rest of the HCD process.

During the second phase of work, Agncy led a process of translating the insights and learning from Phase 1 into a concept for the Practice of the Future model. Through a series of four co-creation sessions facilitated by Agncy, a concept for a model emerged that can be prototyped, iterated and refined within the practice. Participants in these sessions included the Center team, key BMC leadership, providers, family navigators, social workers, medical assistants, child life specialists, program leads, families interviewed in Phase 1 and the Pediatric Family Advisory Board.

Based on the priorities identified by our families, the Center has defined the overarching attributes that will be essential to the Pediatric Practice of the Future. The emerging framework for the Practice of the Future focuses on supporting resilient family development achieved through implementation of these core components:

  1. Embedded economic mobility services 
  2. Options for care content and delivery that are customizable, yet offered in a systematic way
  3. Care and services within and outside of health care assessed and streamlined
  4. Opportunities to bolster social networks
  5. Using technology for health promotion and communication, coordination and integration with community based organizations
  6. Developing a holistic approach supporting the resiliency and wellness of the family
  7. Impact of structural racism and economic oppression, is acknowledged and mitigated and incorporated into care practices
  8. Intentional and systematic approach to workforce development that empowers all employees to operate at the highest level of their skillset

Beginning in January 2020, the Center will deploy an innovation team to pilot the new model in the primary care pediatric clinic. This innovation team will include care team members already embedded within the practice, as well as new roles including a Community Wellness Advocate, a scale and sustainability consultant and an Innovation Improvement Advisor. The Pediatric Practice of the Future will enroll 30-50 families with infants, concentrating on families living in Dorchester, Mattapan and Roxbury. Deep community partnerships—with shared accountability for families—will facilitate efficient, streamlined care directed by families’ needs. The innovation team will engage in rapid tests of change, led by the Innovation Improvement Advisor who has quality improvement expertise. The model will be iteratively improved with the goal of scaling core components to the practice over time.