Design from Within

Transforming Healthcare Quality from Within: Embedding Human-Centered Design in Medicare Quality Improvement

Summary

A Centers for Medicare & Medicaid Services (CMS) Quality Improvement contractor partnered with Accenture Digital Services to transform their approach to healthcare quality. We designed and delivered an immersive human-centered design (HCD) program that equipped quality improvement leaders with practical design skills through hands-on, project-based workshops. This initiative empowered leaders to apply design thinking directly to critical healthcare challenges while building internal capabilities that continue to drive innovation throughout the organization.

Challenge: Revolutionizing Data Collection in Nursing Homes

Nursing homes struggle to collect accurate, real-time data that quality improvement organizations (QIOs) need to measure intervention effectiveness. This data gap prevents timely adjustments to care protocols and hinders quality improvement efforts. Our team tackled this challenge: How might we inspire and enable nursing homes to collect accurate real-time data that drives measurable improvements in patient care?

Approach: Learning by Doing

Our “Design from Within” program rejected traditional classroom training in favor of an experiential learning model that immersed participants in real-world healthcare challenges. The program followed four progressive phases:

Foundation Building: Participants developed research questions, crafted investigation plans, and mapped complete ecosystems, including edge cases that traditional approaches often miss.

Guided Execution: Teams conducted actual field research with expert coaching, transforming inevitable missteps into valuable learning opportunities through structured analysis and rapid iteration.

Co-creation Leadership: Participants synthesized research insights into actionable “How might we?” questions and led collaborative solution-generation sessions with diverse ecosystem stakeholders.

Organizational Integration: Leaders identified strategic opportunities to apply these methodologies within their teams and developed plans to train others, creating a multiplier effect throughout the organization.

Design professionals provided both on-site facilitation and remote coaching throughout the project, gradually shifting from directive to supportive roles as participant capabilities grew.

Transformative Insights: New Ways of Seeing

Participants experienced fundamental shifts in perspective that transformed their approach to quality improvement:

Methodology Transformation: “Design thinking approaches problems completely differently than our scientific methodologies. It opens possibilities we never considered before.” – Quality Improvement Director.

Expanded Horizons: “We’ve been trained to focus on immediate problems, but design thinking pushed us to explore beyond what’s broken to what could be possible.” – Program Participant

Fresh Perspective: “Looking at nursing homes with ‘beginner’s eyes’ felt uncomfortable at first but revealed behaviors and needs we’d been blind to for years, despite visiting these facilities regularly.” – Field Researcher

Collective Intelligence: “I was skeptical about bringing diverse stakeholders together but letting go of control during co-creation sessions generated solutions far better than what we could have developed internally.” – Team Leader

Process in Action: Human-Centered Design Applied to Healthcare

Participants applied a structured four-phase HCD process to address real nursing home data collection challenges:

Discover

Participants defined specific design opportunities using “How might we…?” framing and built deep empathy through immersive research techniques. Teams:

  • Created comprehensive ecosystem maps of nursing home data flows
  • Conducted 32 on-site observations across 14 facilities
  • Interviewed 47 stakeholders, including nurses, administrators, and patients
  • Analyzed existing research and regulatory requirements

Describe

Teams transformed research into actionable insights by:

  • Creating affinity clusters to identify patterns across diverse data sources
  • Developing five distinct user mindsets that explained different attitudes toward data collection
  • Synthesizing interviews, site visits, and observations into key opportunity themes
  • Mapping critical journeys that revealed major pain points in the data collection process

Co-create

Participants leveraged collective intelligence to generate innovative solutions by:

  • Organizing collaborative sessions with 18+ diverse stakeholders
  • Generating 287 distinct solution ideas through structured brainstorming
  • Using reframing techniques to overcome apparent constraints
  • Prioritizing solutions based on impact potential and implementation feasibility

Develop

Teams created and refined solution prototypes through:

  • Developing concept cards that communicated core solution ideas
  • Building physical and digital prototypes to test with actual users
  • Testing prototypes in four local skilled nursing facilities
  • Iterating designs based on direct user feedback
  • Finalizing four implementation-ready solutions

Impact

The “Design from Within” program delivered both immediate project outcomes and lasting organizational change:

  • Immediate Solutions: Four ready-to-implement prototypes now address critical nursing home data collection challenges
  • Team Transformation: Participants report stronger, more unified teams through regular application of HCD tools in team meetings
  • Cultural Shift: “The way we approach problems has fundamentally changed. We now start with user needs rather than technical requirements.” – Program Director
  • Capability Building: Seven participants have gone on to lead design-focused initiatives in their respective departments
  • Methodology Adoption: Three HCD methods have been incorporated into the organization’s standard quality improvement methodology

Key Principles for Success

The program revealed seven essential principles for embedding design capabilities in healthcare improvement organizations:

  • Start with clarity: Define specific, actionable design opportunities before beginning research
  • Build genuine empathy: Understand the people you’re designing for through direct observation and engagement
  • Embrace co-creation: Involve diverse users and stakeholders to develop solutions with built-in relevance and buy-in
  • Prototype everything: Use tangible models to validate assumptions and reveal unexpected insights
  • Iterate relentlessly: Gather user feedback and continuously refine solutions
  • Learn by doing: Develop design capabilities through hands-on experience with real challenges
  • Embed and sustain: Integrate design methodologies into existing organizational processes and teams

Final Concept Posters FROM WORKSHOP