CHANGING HOW WE CARE: Moving from Medical to Social Solutions

In October of 2011 I presented a project at the Global Service Design Conference in San Francisco with colleague Ali Baba Attaie. The work is being managed by HelloLAB and challenges designers and business leaders to rethink the healthcare experience in underserved communities in New York City. In addition, our article on our work was accepted by Touchpoint, the Service Design Network quarterly and is now available for purchase.
Below is the article as it appears in the publication:

Innovating the dental care experience for underserved communities in New York City

By Liz Burow, Creative Director, hellosmile and Ali Baba Attaie, DDS, FAAPD
Director, Pediatric Dental Medicine, Mount Sinai Pediatric Dental and co-founder of hellosmile.

Tooth decay in children is a big problem. Tooth decay is largely preventable yet it remains the most common chronic disease among children and adolescents ages 6 to 19 (1). For children from low-income communities, tooth decay is even a bigger problem, as they carry a significantly larger disease load but have less access to care compared to more affluent communities. Pain from untreated tooth decay is so severe that it prevents millions of children from eating, sleeping, and learning (2). For communities with large disease loads, few solutions are being offered by the health care profession that are innovative enough to holistically address this epidemic problem’s root causes.

For many socio-economically disadvantaged families in the United States, receiving dental care is impractical, costly, or inaccessible. In addition, many low-income communities consider a trip to the dentist as emergency treatment, rather then a preventative measure. So, even when patients come in for treatment, it doesn’t mean they’ll come back. In the communities hellosmile serves in New York City (3), on average, only twenty percent of patients return for regular-check-ups. This creates a market for invasive ‘drill and fill’ treatment, where the dentists time is spent fixing existing problems, rather than trying to communicate how to prevent problems from occurring in the first place. A typical dental clinic in a low-income community runs on a business model that is 70% invasive treatment care and 30% preventative care.

In order to tackle America’s most common chronic childhood disease we need to change how we care and invert the typical 70/30-business model to provide low-cost, efficient and effective preventive health care solutions. At hellosmile, our solution is centered on a service blueprint grounded in prevention through 1) engage children and families with patient centered approaches, 2) empower mid level providers as oral health champions, and 3) connect communities through the exchange of information and collaboration of stakeholders. With these approaches we work to build an ongoing dialog about healthy eating habits that effect not only oral health but also the health and wellness of the entire body. Our goal is to create stronger, more self-reliant communities by designing conversations, spaces, incentives, products and toys that are choreographed to create a “WOW!” experience for our staff, our patients and their families.

To create this experience, we are focused on two areas that help our preventative care message stick: talent recruitment and customer retention. Our preventative care business model is dependent on our patients and their families returning for regular check-ups and modifying health behaviors like brushing twice a day and finding alternatives to sugary snacks based on conversations with our health-care providers. To do this, our patients must have a trusting and engaging relationship with hellosmile from the very first phone call and all the way through to each fond farewell.

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Developing a sequenced narrative helps guide our ‘hosting’ staff through important touch-points and conversations.

In our service blueprint, the person most empowered to help communicate the importance of preventative care is the hello buddy. The hello buddy, a mid-level provider and registered dental assistant, ‘hosts’ the child and parent at the clinic to make sure they have a comfortable and engaging experience, encourages behavioral change through education and information sharing and provides a wide range of preventative oral treatments under the guidance of an attending dentist. In this new clinical business model, we find that emphasizing the role of hello buddies lowers the treatment cost under the supervision of dental professionals.

Creating charismatic hello buddies puts particular emphasis on cultural sensitivity, recruitment and the professional development of our mid-level provider. Our model is based on the idea that patients are more likely to listen to a provider who seems familiar and similar to them. Our recruitment is founded on an entry-level work force typically hired from the neighborhoods the hellosmile clinic serves. Such mid level providers are more motivated to provide preventive dental services than the dentists whose primary focus is to treat active acute disease. To further align the needs, perceptions and understanding between patients and providers courses and on-the-job training are co-created and co-taught with employees, doctors, team leaders, IT professionals and designers . Workshops help our staff understand their ‘hosting’ responsibilities and assist in active patient/family engagement. In addition, outreach and volunteer opportunities empower staff to become community change agents and health ‘champions’ beyond their time as employees of hellosmile.
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Entry-level team members participate in training workshops to learn how to better engage in chair-side conversations about patient history and eating habits. 

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health buddies participate in Givesmile, our sister outreach program that travels to day-cares, churches, schools and health fairs within clinic serving neighborhoods, to teach kids and parents about the importance of brushing, visiting the dentist and eating healthy snacks.

Hello buddies engage and motivate our patients to return for regular check-ups by enrolling patients as members of our Passport Incentive Program. The program is a series of conversations and incentives that are expressed through the design of our clinics that include the spaces, toys, graphics, products, and interactions with patients. At the center of the program is the hellosmile Passport, which acts like a membership rewards card and is given to children upon their first visit. For the hello buddy, the Passport Program provides a series of conversation prompts and props to engage parents in chair-side discussions about causes for dental disease, the importance of brushing, and eating tips that promote better oral health. Most importantly, the Passport Program creates a reward for returning for the next preventive visit: small prizes for coming to scheduled appointments that culminate in a raffle ticket for a quarterly grand prize drawing. Prizes like Nintendo Wii gaming consoles are selected for their popularity as well as encouraging physical activities shared between parents and children.

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The hellosmile Passport documents check-up attendance, and facilitates conversations around healthy eating and brushing habits.

We strongly believe that service design thinking can change the healthcare landscape within under-served and low-income communities. Until now, most design services have not penetrated this market, due in part to a client perception that ‘design’ is costly, unnecessary or inaccessible. In response, we have established hellolab, a non-profit innovation lab that brings together business leaders, designers and health care professionals into a studio setting where people can work, meet and share data, ideas and sketches as they research and develop appropriate service models . Hellolab’s objective is to make design accessible and affordable to communities who can greatly benefit from design strategy and service design thinking.

Our vision is to help eliminate childhood tooth decay in every community served by hellosmile. While our goals are big, each project begins with a conversation where we look at ‘bits’. Service design thinking helps us understand how all the ‘bits’ come together as a whole experience and why it matters. The tools and techniques of service design like creating personas, storyboarding, experience prototyping, role-playing and affinity mapping help facilitate more constructive, user-focused conversations between our multi-disciplinary team members and helps us figure out how to make our ideas happen. Service design helps us turn our spreadsheets into sketches of efficient systems and inspiring experiences and then eventually back into spreadsheets as we gather more data, evidence and experience. We hope to see more service-driven innovations and effective problem solving that address the needs of under-served communities, in our community and in yours.

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At hellosmile we celebrate the magic of every child



1 According to the U.S. Center for Disease Control and Prevention

2 Oral Health in America: A Report of the Surgeon General, National Institute of Dental and Craniofacial Research, National Institutes of Health, U.S. Department of Health and Human Services (DHHS), 2000. 

3 hellosmile PMG has clinics in Woodside, Sunnyside, Corona, Jackson Heights, North Central Bronx and Parkslope and treats an average of 2000 of children/month.
Liz Burow is a design strategist that works with organizations to help them express their values through memorable experiences and spaces. She teaches visual thinking studios at Parsons School of Design in NYC and holds a Masters of Architecture from MIT. Recent projects include social-media driven curriculum development, public art, brand identity, interior design and theatrical set design. She is currently a consulting creative director to hellosmile in NYC.

His younger patients better know Ali as Dr. Ali Baba. He is a pediatric dental specialist with active private and hospital based dental surgery practices in New York City. A Tehran native and San Francisco transplant, Ali is now a Brooklynite and works with his extended family and an amazing team of health care workers/providers and designers at a network of pediatric dental and medical clinics spread across Brooklyn, Queens and the Bronx where innovative experiences help deliver high quality dental and medical care to all children with a special focus on under-served communities.