human-centered design as an approach for place-based...
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NOTES FROM THE FIELD
Human-Centered Design as an Approach for Place-BasedInnovation in Public Health: A Case Study from Oakland,California
Jessica Vechakul1 • Bina Patel Shrimali2 • Jaspal S. Sandhu3
� Springer Science+Business Media New York 2015
Abstract
Purpose This case study provides a high-level overview
of the human-centered design (HCD) or ‘‘design thinking’’
process and its relevance to public health.
Description The Best Babies Zone (BBZ) initiative is a
multi-year project aimed at reducing inequities in infant
mortality rates. In 2012, BBZ launched pilot programs in
three US cities: Cincinnati, Ohio; New Orleans, Louisiana;
and Oakland, California. The Alameda County Public
Health Department (ACPHD), the lead for the Oakland
BBZ site, identified HCD as a promising approach for
addressing the social and economic conditions that are
important drivers of health inequities. HCD is a process for
creating innovative products, services, and strategies that
prioritizes the needs of the intended population. ACPHD
partnered with the Gobee Group (a social innovation
design consultancy) to develop the Design Sprint. The
Design Sprint was a 12-week pilot in which 14 profes-
sionals from nine organizations used the HCD process to
develop concepts for stimulating a vibrant local economy
in the Oakland Best Babies Zone.
Assessment Thirty- to sixty-minute semi-structured
interviews were conducted with all 14 individuals involved
in the Design Sprint. With the exception of one interview,
the interviews were audio-recorded, transcribed, and
inductively coded to identify themes.
Conclusion Our experience suggests that HCD can:
enhance community engagement; expedite the timeframe
for challenge identification, program design, and imple-
mentation; and create innovative programs that address
complex challenges.
Keywords Human-centered design � Place-based
innovation � Social determinants of health
Significance
The Design Sprint set a foundation for community-driven
innovation, and demonstrates the potential value that HCD
offers for the field of public health.
Introduction
Theoretical Foundation of the Best Babies Zone
Place has a significant influence on the health of individ-
uals and communities [1, 2]. The Best Babies Zone (BBZ)
Initiative is a national multi-year project that recognizes
the influence of place, the need to address social determi-
nants of health, and the opportunities afforded by positive
experiences throughout the life course [2, 3].
BBZ’s vision is that ‘‘every baby is born healthy, into
communities that enable them to thrive and reach their full
potential’’ [4]. BBZ aims to decrease inequities in infant
mortality rates and enhance overall population health and
wellness. In 2012, BBZ launched pilot programs in three
& Jessica Vechakul
Bina Patel Shrimali
Jaspal S. Sandhu
1 University of California, Berkeley, Berkeley, CA, USA
2 Alameda County Public Health Department, Oakland, CA,
USA
3 Gobee Group, Oakland, CA, USA
123
Matern Child Health J
DOI 10.1007/s10995-015-1787-x
US cities: Oakland, California; New Orleans, Louisiana;
and Cincinnati, Ohio.
As a place-based initiative, BBZ recognizes the impor-
tance of geographic, cultural, and institutional context and
leverages community social capital, values, and embedded
local knowledge to support community transformation [5].
Recognizing that ‘‘supportive community environments—
access to healthy food, safe and appealing parks, high quality
housing and education, job opportunities, clean air and water,
resources to save and build financial assets, and other com-
munity factors—are key to good health,’’ BBZ is coordi-
nating projects across four domains: economic development,
community systems, health, and education [4, 6].
Given the interrelated and complex factors that contribute
to health inequities, developing interventions that address
systemic issues can be difficult [7–9]. Alameda County
Public Health Department (ACPHD), the lead agency for
BBZ Oakland, created the Design Sprint, a 12-week pilot
exploring the potential of HCD to develop novel programs
in response to deeply-rooted, complex challenges in BBZ
Oakland. This case study provides a high-level overview of
the HCD process and its relevance to public health, based on
reflections from the Design Sprint participants.
Overview of Human-Centered Design
Human-centered design (HCD) or ‘‘design thinking’’ is a
process for innovation1 that prioritizes the needs and values
of the people most affected. HCD provides a framework for
moving quickly toward action while retaining a systems
perspective. The HCD process can be structured in three
phases: Understanding, Ideation, and Implementation (see
Fig. 1). Understanding is ‘‘[the process of identifying] the
problem or opportunity that motivates the search for
solutions;’’ ideation is ‘‘the process of generating, devel-
oping, and testing ideas;’’ and implementation is ‘‘the path
that leads from the project stage into people’s lives’’
through prototyping, iteration and refinement [10].2
Many corporations use HCD (e.g., Intel, Intuit, Procter
& Gamble) to develop successful consumer products and
business strategies. HCD focuses on ‘‘understanding people
in context and from their own perspectives, testing various
solutions on a small scale, and continuously iterating
through this process’’ [11]. It is more commonly practiced
in healthcare than in public health; however, some public
health professionals practice the principles of HCD without
necessarily calling it by that name, given that some HCD
principles are intuitive or overlap with other practices.
Design firms, healthcare organizations, start-ups, and
innovation networks (e.g., IDEO, Kaiser Permanente,
Mayo Clinic, Omada Health, Center for Care Innovations)
are using HCD to create innovations in medical devices,
patient experiences, and healthcare systems [12].
Application of HCD in Best Babies Zone Oakland
BBZ Oakland is situated in the Castlemont neighborhood
of East Oakland. With about 400,000 residents, Oakland is
the third most populous city in the San Francisco Bay Area,
after San Jose and San Francisco [13]. The Castlemont
neighborhood is defined by a 7-by-12 block census tract,
where poverty rates indicate a high level of need. Of the
5000 residents in Castlemont, one in four residents lives in
poverty, and almost half of residents have a household
income \US$30,000 per year [14]. Of the approxi-
mately 100 infants born per year in Castlemont, 13 % are
born low birth weight and 15 % are born prematurely [15].
Castlemont is among the census tracts receiving the most
services in Alameda County [4]. These services (e.g., food
stamps, welfare, etc.) are designed to address critical short-
term needs; however, they do not address long-standing
root causes of health inequities. Addressing social deter-
minants of health may have an impact by reducing chronic
stressors that have been linked to multiple health outcomes.
As identified by community assessments, the priorities
of Castlemont residents include supporting and expanding:
employment opportunities; local businesses providing ser-
vices and goods; social cohesion; and programs to address
UNDERSTANDING IDEATION IMPLEMENTATION
observe & inspire
tell stories
synthesize insights
brainstorm
create concepts
prototype
test & refine
scale, spread, sustain
Fig. 1 In the Understanding Phase, design teams observe what
people do and say to uncover their needs. They tell stories to evoke
empathy and inspire ideas. In the Ideation Phase, they rapidly
brainstorm a broad range of ideas, and select the most promising
concepts to test. In the Implementation Phase, they prototype or
conduct tests to refine a solution that can be scaled, spread, and
sustained. Since the HCD process is iterative, design teams may cycle
through each phase multiple times. This figure is based on a figure
used in a presentation created by IDEO.org [24]
1 Innovation is the creation of new ideas or novel applications of
existing ideas that add value.2 There are many ways to represent the HCD process. HCD is a fluid
process that is most effective when it is adapted to suit different
contexts. It is not a standardized static process, in which the same
sequence of steps and methods are applied in all contexts.
Matern Child Health J
123
violence. Of these priorities, ACPHD had the most expe-
rience in economic development [6]. Statistics also con-
firmed the need for economic development. The
unemployment rate in Castlemont is three times higher
(30 %) than that in Alameda County (10 %), and 97 % of
residents surveyed indicated that jobs were ‘‘very impor-
tant’’ [16]. ACPHD recruited 14 professionals from nine
organizations based on their expertise in economic and
community development, and interest in HCD. Several of
these professionals were part of an existing working group
on economic development and all had prior connections to
ACPHD staff. This team met for 2 hours per week to learn
the HCD process and to generate concepts for stimulating a
vibrant local economy in Castlemont.
There is significant variation in the way that HCD is taught
and practiced; and several elements of the Design Sprint were
unique. HCD training programs [17] typically provide an
overview of the HCD process, and guide participants in
addressing a predefined design challenge at an accelerated
pace without intention to implement. It is also common for
professional HCD consultants to design compelling concepts
for client organizations without teaching HCD. The Design
Sprint exemplifies a learning-by-doing model, which builds
capacity for client organizations to practice HCD themselves.
The Design Sprint is one of the first HCD training programs in
which an interdisciplinary team worked across sectors to
address an open-ended public health issue in a community
while simultaneously learning the HCD process.
Methods
This case study describes how various HCD principles were
integrated into the Design Sprint’s activities (see Table 1).
For program improvement purposes, 30–60 minute semi-
structured interviews were conducted with all 14 individuals
involved in the Design Sprint. With the exception of one
interview (for which handwritten notes were coded), the
interviews were audio-recorded, transcribed, and inductively
coded to identify themes. This case study is an illustrative
example of how HCD can be applied in public health and
does not provide a step-by-step guide for how to replicate
this program. There are existing toolkits describing HCD
methods and how to use them in various situations [17–19].
Results
HCD Principles Applied in the Design Sprint
Team Diversity Stimulates New Ways of Thinking
Teams are critical to HCD, especially those that are able to
share their processes and cross-pollinate ideas across
disciplines [20, 21]. Working in diverse teams challenges
assumptions and stimulates new ways of thinking. The
Design Sprint team was a diverse group representing
organizations from multiple sectors including government,
design, community development, and economic develop-
ment. A Design Sprint participant stated, ‘‘What was really
effective was learning with such a unique group of people
that all wanted to learn and had really different talents and
skills.’’ Most members of the Team had no formal design
training, but each team member had expertise relevant to
the design challenge of developing a vibrant economy (see
Table 2).
Immersion Deepens Empathy
HCD encourages immersion in the community to deepen
empathy [21]. Most Design Sprint meetings were held at
Youth UpRising, a community-based organization in the
Castlemont neighborhood. Working in the neighborhood
enabled the team to develop a familiarity with the context
that deepened their understanding and empathy.
During two neighborhood walks in the Understanding
Phase, the team observed the physical environment and
talked with residents about topics related to the local
economy, such as small business, informal economy, and
childcare. HCD teams not only note what people do and
say; they also infer motivations and emotions [21]. A De-
sign Sprint participant describes the process of inferring
deeper meaning: ‘‘Observing the physical aspects of the
neighborhood, like how many fences there were and how
many ‘beware of dog’ signs there were—it just felt like
everyone is scared and closed off.’’
Moreover, informal conversations during the neighbor-
hood walks enabled the team to develop a more balanced
view of the community that extended beyond statistics
about poverty and crime rates. A key insight was that there
are many people in the community driving positive change
like organizing movie nights to give kids a safe space to
hang out, or giving free haircuts as a reward for students to
earn good grades.
Reframing the Challenge Integrates Insights into Solutions
Struggling with how to frame a problem is a significant
portion of the challenge, and highly influences the realm of
solutions [22]. The challenge for the Design Sprint was
intentionally framed broadly to force facilitators and par-
ticipants to grapple with the uncertainties and complexities
of framing a problem. Halfway through the 12-week
Design Sprint, the team synthesized insights about the
community to reframe and focus the challenge (see
Table 3). The team retained the high-level goal of systemic
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change (‘‘vibrant local economy’’), and reoriented towards
actionable solutions (‘‘a visible small win’’) because of a
collective recognition by the group that small, visible
successes would build momentum for community
improvement. By stating the intention to ‘‘work with
community members’’ and ‘‘leverage existing assets and
resources,’’ the team explicitly recognized the importance
of supporting community leadership and strengths.
Table 1 The 12-week Design
Sprint covered the
Understanding and Ideation
Phases, and started the
Implementation Phase. Due to
staffing shifts and the need to
seek additional funds, the
Castlemont Community Market
launched 6 months after the
Design Sprint.
Understanding
Week 1 Orientation and team building
Week 2 Neighborhood walk 1: observe environment and talk with people
Week 3 Form insights from observations. Review community assessments
Week 4 Share top 3 insights
Week 5 Neighborhood walk 2: observe environment and talk with people
Week 6 Synthesis of Understanding Phase
Ideation
Week 7 Reframe question
Week 8 Brainstorm concepts to address design challenge
Week 9 2 9 2 matrix to categorize concepts by impact and timeframe
Week 10 Select top 4 concepts
Implementation
Week 11 Prototype concepts. Gather community feedback
Week 12 Group discussion and selection of community market concept
Table 2 List of organizations and sectors involved in the Design Sprint
Organization name Sector Representative’s role and expertise
Alameda County Public Health
Department
Government One staff member facilitated the Design Sprint. Three staff members participated in the
process and assisted with managing details and logistics
Gobee Group Design Social innovation design consultancy with expertise in innovation strategy, policy research,
and human-centered product and service design. Represented by a design and public
health expert, who advised the ACPHD facilitators on the HCD approach and methods
Youth UpRising Community
development
Nonprofit that delivers programs supporting education and career, health and wellness, arts
and expression, and civic engagement aimed at community transformation. Represented
by the Director of Community Economic Development, who served as a liaison with the
community
Social Services Agency of
Alameda County
Government Government agency that provides services, such as food stamps, welfare, health insurance,
and emergency shelter. Represented by an expert in economic development, policy
analysis, and policy advocacy
Federal Reserve Bank of San
Francisco
Economic
development
Represented by the Northern California Regional Manager of the Community Development
branch, which invests in low-income communities
East Bay Sustainable Business
Alliance
Economic
development
Business association supporting locally-owned businesses. Represented by the Director,
who has experience promoting local spending, developing financial services for low-
income individuals, and setting up a community market
Mandela MarketPlace Community
development
Non-profit that supports community members in the development and operation of
cooperative food enterprises. Represented by Director of Social Enterprise and
Microfinance
East Bay Asian Local
Development Corporation
Community
development
Non-profit that develops and manages high quality affordable housing and commercial
spaces, while fostering increased economic opportunities for low-income families and
individuals. Represented by the Design and Communications Manager with expertise in
community economic development and healthy neighborhoods
Y&H Soda Foundation Economic
development
Foundation supporting the well-being of the underserved in Alameda and Contra Costa
Counties. Represented by a Program Officer with expertise in family economic success
strategies, workforce and economic development, employment, and asset building
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Embracing Ambiguity Creates Opportunities to Explore
New Directions
HCD is an open-ended process that has no predefined
outcomes. Embracing ambiguity creates opportunities to
explore new directions on the path to innovation. A par-
ticipant described the Design Sprint as community out-
reach ‘‘without a completely set agenda.’’ Reflecting upon
how the Design Sprint differed from typical approaches in
her field, a participant commented on how the team went
into the community with an open mind: ‘‘I really just want
to hear what [community members] have to say. I really
want to look and see what I see. I really just want to take
things in before I start narrowing things down and making
assumptions.’’
Based on insights from the Understanding Phase, the
team brainstormed over 100 concepts (see examples in
Fig. 2) to address the design challenge. Participants were
encouraged to put forth wild ideas and be visual to
encourage creative thinking. Team members worked in
pairs to select the most promising concepts and then
organized the remaining 11 concepts in a two-by-two
matrix to select the top four concepts, based on what is
achievable in the short-term and has potential for high
impact (see Fig. 3). A facilitator commented on the
importance of dedicating significant time towards the
Understanding and Ideation Phases: ‘‘Forcing ourselves to
spend more time coming up with ideas, or finding alter-
native data pieces in the neighborhood, allowed us to have
a richer end product.’’
Prototyping Enables Fast and Affordable Learning
The team made poster boards of the top four concepts: a
community market (see Fig. 4), murals created by youth,
local newsletters, and child-friendly spaces in businesses.
The team organized interactive sessions at Center of Hope
Church, Castlemont High School, and a local business to
gather feedback on what community members liked, what
Table 3 The Design Sprint team reframed the challenge to integrate insights about the community
Initial challenge How might we build a vibrant economy in the Castlemont neighborhood?
Reframed
challenge
How might we work with community members and leverage existing assets and resources to support a visible small win to
build a vibrant local economy in the Castlemont neighborhood?
Fig. 2 The Design Sprint team generated over 100 ideas. These sketches depict two of the ideas (a community space that could host art events,
businesses, or other events; and a baby clothes consignment area at a community market)
Low Impact
Short-term
High Impact
Long-term
XX
XX X
XX
X
Fig. 3 In HCD, two-by-two matrices are used for qualitative
comparisons of large numbers of concepts, with each axis represent-
ing a distinct dimension, usually ranging from low to high. Gobee,
with its emphasis on social impact, typically uses dimensions such as
time-to-implement, risk, cost, and impact
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they would change, questions, and new ideas. Small and
simple tests (e.g., interactive poster sessions) enable HCD
teams to learn quickly and affordably to evolve solutions,
and also directly engage residents in program planning
[20]. The team integrated community members’ creative
ideas at an early stage of the program planning process,
rather than getting feedback on minor changes after the
fundamental design had been completed. Based on com-
munity feedback, the team decided to implement the
community market concept. Following through on their
intention to leverage existing assets and resources, ACPHD
partnered with community members and organizations in
Castlemont (e.g., Youth UpRising and Castlemont High
School) to implement the Castlemont Community Market.
The Market has been held on the first Saturday of each
month since December 2013.
Preliminary Program Impacts
The Market is an example of how HCD starts with a ‘‘small
win’’ to create momentum to address systemic economic
development issues. In 2014, the Market hosted a total of
20 vendors, generated US$3212.60 in profit for vendors,
and attracted 585 attendees [23]. Increasing vendor sales
and market attendance (see Fig. 5) are indications of the
positive response of residents towards the Market. These
intermediate economic outcomes suggest that the Castle-
mont Community Market is meeting its objectives to
highlight community assets, to support local entrepreneurs
in generating income, and to increase access to services
and goods. Furthermore, the Market has engaged other
entities, including the City of Oakland, to provide business
development resources to Castlemont residents.
In addition to the Market, another outcome of the
Design Sprint was increasing capacity in HCD. Some team
members continue to be engaged with the Market and other
design activities, indicating an interest in Castlemont and
the HCD process. Moreover, ACPHD has been integrating
HCD into their work; ACPHD and Gobee created the
35-week East Oakland Innovators program, in which nine
Castlemont community members learned HCD and created
solutions to issues that they prioritized. The East Oakland
Innovators also represents a paradigm shift in the field of
HCD from the notion that only experts can design to the
notion that anyone can design.
Limitations
Although the team highly valued community leadership,
they were constrained by the program’s grant timeframe
and did not have adequate time to thoughtfully select
Fig. 4 This is one of the four
poster boards created by the
Design Sprint team to convey
the top four concepts to
community members during
feedback sessions
Fig. 5 In 2014, vendor profits at the Castlemont Community Market
increased from US$209 in the 1st quarter to US$1119 in the 4th
quarter, and market attendance increased from 61 attendees in the 1st
quarter to 185 attendees in the 4th quarter [23]
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residents to be on the design team. Moreover, it felt pre-
mature to include residents as team members, since the
team was still learning HCD. A facilitator explains, ‘‘We
were really seeking ways to meaningfully engage residents
and not tokenize their participation.’’ The team intention-
ally leveraged the Design Sprint and the concepts that
emerged from it as ways to build relationships in the
community and prepare for increased participation. To
support community leadership, ACPHD will be forming a
Vendor’s Association that will eventually lead and sustain
the Market. Moreover, the Design Sprint informed the
design of the East Oakland Innovators program, which
situated ownership with community members in order to
build capacity and sustain efforts for neighborhood change.
Discussion
Our experience with the Design Sprint suggests that HCD
offers potential value for the field of public health. The
Design Sprint served as a way to deepen understanding of
the neighborhood and to build relationships with the
community, as most of the organizations involved did not
work in Castlemont directly. HCD enabled the team to
understand the strengths of residents and assets of the
neighborhood, which presented a positive counterpoint to
the bleak picture painted by neighborhood statistics, and
revealed opportunities for intervention. Moreover, the
Design Sprint set a foundation for community-driven
innovation.
In public health, there may be a tendency towards
immediate action and uneasiness with open-ended pro-
cesses that have no predefined outcomes. HCD is a sys-
tematic process that helps people embrace ambiguity and
generate new insights and ideas. We believe that HCD can
provide a structured process to systematize innovation in
public health, shorten planning timeframes, and co-create
with community members and cross-sector partners.
In addition, HCD provides a structured and inclusive
process that does not rely on a visionary leader, but rather
leverages the strengths and insights of the team and com-
munity members to increase the likelihood that the solution
will be successful. We believe that the team does not need
formal design training, but should bring relevant domain
expertise and also respect community members as experts.
Each member of the Design Sprint team had expertise
pertinent for developing a vibrant economy, and recog-
nized that community members have critical insights.
Furthermore, prototyping is a way to identify and refine
promising ideas to make the most efficient use of resources.
By prototyping, design teams can learn from fast, simple
tests, and integrate lessons learned to develop a more
robust solution. Similarly, implementation means starting
small and continuing to iterate through the HCD process
for continuous improvement, scale-up, and sustainability.
The Design Sprint demonstrates that starting small can be a
way to address systemic issues.
HCD has been a helpful planning and implementation
approach for ACPHD’s BBZ team where collaboration,
innovation, and community engagement are needed to
address the root causes of health inequities. We believe that
in order to best integrate HCD, organizational leaders and
funders must build a culture of collaboration [6] and sup-
port innovation [20]. Our approach to HCD demands that
interdisciplinary teams bring forth diverse skills and per-
spectives to challenge one another to collectively innovate.
Also, maintaining dedicated staff time on a daily or weekly
basis provides momentum and flexibility to explore cre-
ative ideas as they arise. We hope that this case study of the
Design Sprint will encourage other public health depart-
ments or organizations to explore and practice HCD.
Acknowledgments The Best Babies Zone (BBZ) initiative is led by
University of California, Berkeley School of Public Health. BBZ
Oakland is a project of the Building Blocks for Health Equity unit of
the Alameda County Public Health Department (ACPHD), and has
received funding from the California Wellness Foundation, the Cal-
ifornia Endowment, and the W.K. Kellogg Foundation. ACPHD
facilitated the Design Sprint with technical assistance in human-
centered design from the Gobee Group (Gobee). We gratefully
acknowledge the contribution of the Design Sprint participants,
Castlemont community members, and partner organizations (East Bay
Asian Local Development Corporation, East Bay Sustainable Busi-
ness Alliance, Federal Reserve Bank of San Francisco, Gobee Group,
Mandela MarketPlace, Social Services Agency of Alameda County,
Y&H Soda Foundation, Youth UpRising), and staff and partners who
are implementing the Castlemont Community Market. We also
appreciate Cheri Pies, Kiko Malin, Jessica Luginbuhl, Rachel
Berkowitz, Mariela Uribe, Jonathan Fuchs, and Kellie Teeter for their
thoughtful and constructive review.
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