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After completing initial design research with Veterans across the country to understand their care experiences, the Department of Veterans Affairs (VA) understood the need to improve the customer experience at VA medical facilities. Shortly thereafter, the VA Patient Experience (PX) initiative was born. The agency developed tools to enhance the care delivery process and began training frontline staff members to put the Veteran at the center of their interactions.


However, leaders of the PX initiative realized something was missing. The facilities need a way to incorporate a new way of being into their strategies and operations. There was a fear that facilities would not fully embrace and adopt the initiative and its programs despite all evidence pointing to a need for change. In order to avoid being another “flavor of the month,” VA sought out to understand the best way to integrate, launch, and maintain the PX initiative across VA's 152  healthcare systems. What might we learn from past initiatives that have either succeeded or failed?


Design Research

Design Strategy

Content Strategy, Low Fidelity Visual Design

Photos: Han Wang, Aaron Steinstra, Veronica X. Vela


We sought to uncover the best way to ensure the patient experience's initiatives were sustainable. Our key question was:


How might we integrate, launch, and maintain a VA's patient experience initiative across 152 healthcare systems and over 1,000 medical facilities?


We also wanted to understand the best context and delivery mechanisms to ensure a successful launch. Who should be the conduit or spokesperson? What is the appropriate timing? Place? Approach? What materials or tools were needed?


We conducted in person and remote telephonic interviews with clinical and administrative leaders at medical centers. These people would be responsible for the launching and sustaining the initiative locally.  We wanted to understand what made an initiative a success or a failure at their medical facility.   

We identified a diverse group of high, moderate and low performing facilities to conduct our research. Because facilities are organized differently, we had to pinpoint the right roles to interview. We included those directly responsible and executive leaders who had a large stake in the success or failure of the initiative. We inquired about their experiences launching successful  initiatives and asked about ones that failed. We gathered their ideas, experiences and set the stage to follow up during the prototyping and testing phase.


We don’t communicate as well as we should. Everyone has their own way that they think it should be. 

Behavioral Health Coordinator

Reno, NV

It is a great disservice when you send a cook cutter solution – we need flexibility in funds, positions, and time.

Systems Redesign Expert

Las Vegas, NV

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We conducted synthesis after each interview, often remotely using video or telephone conference calls.  At the conclusion of all the interviews, we gathered in person to synthesize the interviews all over again. We identified key themes across interviews, personas to characterize the facilities, and novel ideas proposed by users.

During the ideation phase, our team developed 36 low prototypes, and settled on 4 solutions to build out further.


We sought feedback from lead users 3 times and conducted multiple rounds of iteration before settling on the final solution: the Patient Experience Roadmap.


We learned that most initiatives in VA fail. Not only because they are poorly resourced, but because there is limited but in for the initiative.


  1. New programs and initiatives are sent by decree from the VA national office using written memos. They are hard for local leaders to interpret.

  2. Local leaders must implement multiple directives simultaneously, leading to lack of focus & initiative fatigue.

  3. Open dialogue fosters understanding and allows staff to align their efforts, yet there is often not adequate time to discuss new initiatives.

  4. Sites need to be able to tailor initiatives to their local environment. One size fits all solutions do not work. 

  5. Since sites are at varying levels of maturity, they need help deciding where to start and also want a roadmap to support their long-term planning.


  • Final Solution: The Patient Experience Roadmap

  • Ideation and Prototyping Deck


Visual Design: Aaron Steinstra


The roadmap was well received by VA's clinical and administrative leaders. VA implementation teams are currently deploying the roadmap to all of VA's 1000+ medical facilities.  The roadmap provides step by step guidance to medical directors on how to implement and secure buy in on VA's national Patient Experience initiative at their sites of care. 

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