Service Design Men's Clinic Insights

PART TWO

Design Research and Strategic Recommendations Inspiring The Cutler Center

Research // Cutler Center for Men's Comprehensive Care www.wondros.com

311 S. Craig Street Pittsburgh PA 15213

32

200

interviews

survey respondents

13

184 approx. articles, case studies, and publications

2

selected insights

Table of Contents

Part Two – Design Research and Strategic Recommendations 01.

Introduction

02.

Survey Findings

03.

Interview Findings, Literature Review & Landscape Analysis

Cutler Center: Design Research and Strategic Recommendations

04.

Learning From Analogous Examples

05.

Opportunity Areas

3

01.

Introduction Initial guiding questions informing brand, identity, and future program opportunities: What contributes to patients being motivated for self-care?

What factors impact patient action?

How will our learnings impact the development of the program, brand, and communications?

4

01. INTRODUCTION

Pilot Roadmap 01

Design Research & Opportunity Definition

Problem Framing

context, experience interactions communication

02

03

04

Opportunity Identification

Communications Strategy

Cutler Identity Engagement, Language, Tone, Voice, Visual Brand

Business Strategy/ Digital Design

05

06

07

Develop Service Features

Pilot design /

Platform design

and Marketing

Service experience prototypes

For 3 audiences: Internal, Patients, Community

‣ Greater awareness of the value of self-care and supportive life long commitments ‣ Community partnerships and creative program design internal and external ‣ Continued expansion of programatic offerings driven by patient core needs ‣ Broadening of prioritization, roadmap, baseline, impact areas for business ‣ Iteration based on feedback from the org / patients and community leaders

Communication, Service, Digital

‣ ‣ ‣ ‣ ‣ ‣

Care team collaboration and approach Mentors Contextual service offerings Messaging Roadmap Refined pilot launch and iteration plan

‣ Short-term features (MVP) ‣ Long-term vision ‣ Planned rollout of versions

Collaboration The Challenge Cutler Center: Design Research and Strategic Recommendations

Design for Transformation

5

01. INTRODUCTION

Beyond Brand: Building the Cutler Experience Platform The Communications Strategy & Programmatic Offerings

Where we’re headed:

Key research findings Inspiration and insights to inform: Brand, Communications, and Programmatic Offerings

Experience and Program Design

Where we want to go:

Strategic framework Brand blueprint Video production Communications strategy

Cutler Center experience platform

Operational strategy and service features piloting Experience design Digital development

Cutler Center: Design Research and Strategic Recommendations

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02.

Survey Findings

02. SURVEY FINDINGS

Men Want To Achieve Wellbeing The term "wellbeing" includes: •

Physical and mental health (87)

•

Living the life I want to live (stability, peace, happiness) (80)

•

The welfare of loved ones (35)

•

The state of their community or the world at large (7)

“

They desire support tailored for their life stage We found that desire for support related to work and building a family were popular options.

• • •

Men expressed interest in services that allow them to talk and share experiences in a non-judgmental space, and to receive advice that can help them achieve their own version of wellbeing.

•

To me, wellbeing means having health and life circumstances that provide for a meaningful and enjoyable life.”

Survey "open text field" response

• • • • •

Cutler Center: Design Research and Strategic Recommendations

Support for men in vocational/trade careers: 58% Advice on becoming a father: 45% Advice on becoming a husband: 40%

Mental and Behavioral Health Services: 70% Life Skills Advice: 57% Caregiving and Family Advice: 55% Fitness/Nutrition Programs: 51% Personalized Administrative Support: 41% Substance Use Support Programs: 13%

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02. SURVEY FINDINGS

Men’s Health Behaviors Men seek support to achieve and maintain health and wellbeing Though a ‘gender gap’ does exist, the men we surveyed and spoke with (especially men under 40 years old) are much less hesitant to go to the doctor as we initially assumed.

Here, we want to build upon what is working for male patients: they want to monitor their health, and are interested in the ‘problem-solving’ and ‘analysis’ aspect of speaking to a health care provider.

“

I hate waiting in the waiting rooms, and I hate having to actually be in there and then wait again. But I do like the analysis portion, because I'm just naturally curious...If I had a monitor to just draw my own blood and tell me what I needed to know, I'd do it.”

–Community Interviewee

Additionally, according to the survey: • 130 had a physical within the past year (65%) • 144 think their doctor is interested in them beyond physical wellness (72%) • 172 of respondents are interested in seeking help to learn about new ways to achieve and maintain wellbeing (86%)

Cutler Center: Design Research and Strategic Recommendations

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03.

Interview Findings, Literature Review & Landscape Analysis

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03. FINDINGS

Care Behaviors

“

There are no shortages of best practices and health care strategies – we just need to modify for men.”

—UH Stakeholder

Patients we spoke with had a variety of care stories illustrating their care experience.

How might we:

Care resistant

Reactive & driven by pain

Semi-proactive care seeking

Feeling supported & understood

Concern about being judged; Fear of rural hospitals (super resistant).

A practical but potentially risky approach.

Many go but don’t feel driven or passionate about why they are going.

The impact of feeling cared for because the provider understands specific needs, has been able to learn about the patient, and is there to treat and listen without judging.

Bring telehealth to rural locations and build self esteem?

Activate these patients at entry points such as urgent care and the emergency room?

Enhance the experience to be desired and not just obligatory?

Infuse the experience at various touch points to include tools for listening and understanding?

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03. FINDINGS

Synthesis of Care Behaviors Self-Esteem Building Blocks Behaviors to optimize while men manage transitions, shifts, and surprises in physical and emotional health Listens and embraces life with gratitude; Has a desire to help and knows you need to take care of yourself to help others

What we want To build

Knows when and how to ask for help (has a trusted resource)

Has the self-esteem to bounce back

Sees oneself as an important part of the whole, with areas to grow and develop

Optimizers

Self reliance and vulnerability

Resilience

Self identity

Generosity

Apathetic Depressed

Indulgent Invincible Short sided Arrogant

Lacks boundaries Gives it all away

+

-

Move away from

Stressed Disconnected Exhausted

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03. FINDINGS

Insight #1

Find ways to give men permission to be vulnerable, hear the real story, and express how they fit in.

Parody, irony, and poking fun can be an effective way to educate

Cutler Expression Build on humor, authenticity, or “no B.S.” tone.

Showing vulnerability can be challenging, but showing examples in a stark light where someone might be “truth talking,” “poking fun,” or incorporating fantasy to make a point may take the pressure off.

and invite men to talk in a comfortable way.

Authentic goals advice from a patient’s partner “The center could be built on the principle of denormalizing dysfunction– mental, physical, social, or economically. That should be a goal. Pay attention to disparities and have staff that represents multiple perspectives and lifestyles."

—Community Interviewee

Being real through humor "For me personally, when I can make fun of things with my friends and no one gets offended –the type of self-deprecating humor – that is me and my friends 100%. When you can approach things in that way, everyone feels more comfortable. It is out on the table, then it's ok, so "what is next'."

–Community Interviewee

The best 10 super bowl commercials of all time poke fun at traditional masculinity

Using strong no B.S. messaging A man goes to the store and asks for a pack of cigarettes. He throws some money on the counter, but the cashier says, “That’s not enough.” So the young man pulls out a pair of pliers, wrenches out one of his teeth and hands it over. At the end of the tooth-pulling television ad, a voiceover asks: “What’s a pack of smokes cost? Your teeth.”

U.S. Food and Drug Administration’s first youth tobacco prevention campaign, known as The Real Cost.

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #1 - Case Study

Dr. Squatch Soap Co. Authentic “reason to be” and a twist on traditional masculinity

“ “

People want a more personal experience these days,” Parvis said. “If you’re buying a Hanes T-shirt, you don’t feel like you’re a part of anything. You’re also not a part of anything when you’re buying soap from Walmart or Target.”

—Jack Haldrup, founder of Dr. Squatch

…Comedy is about tension creating and releasing tension….

—James Schrader, writer and comedian

"How this 31-year-old makes millions selling soap online" –The Morning Call newspaper

Jack Haldrup, the founder of Dr. Squatch has psoriasis, which makes him a poor match for ordinary, big-brand soaps. They burn his skin, leaving him feeling dry and irritated. He was forced into seeking out natural products that would be less harsh on his skin.

“Our customer is not the guy who already shops at Whole Foods and uses Dr. Bronner’s soap,” Haldrup said. “Our biggest audience turns out to be middle America. This is for the guy who would never normally consider buying natural products because he thinks they’re for hippies.”

The initial “hero video” was immensely successful almost instantaneously, capturing 6 million views in the first 6 weeks. It has now eclipsed over 13 million views on YouTube and Facebook, with record sales and “soapscriptions” to show.

Jack Haldrup, founder of the subscription soap company Dr. Squatch, tests out new soap scents in his “soap lab” garage.

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03. FINDINGS

Insight #2 Communicate the long-term value of patients focusing on their

Cutler as Leverage for Men

health now. This can lead to ongoing reliability. Cutler can be the mediator providing resources that men can use to “take care of things” and be the provider.

It is important for men to be able to help the people they care about.

The men we spoke to want to be able to care for their families and friends. Targeted resources can help men support their family back home, and their ability to be there for family builds self-esteem.

“

I would help them with their sphere of influence. For example, we could say we would help their kids with their financial aid forms or their father get in for a visit, and ask about their community and see how we can help them help those they love."

—UH stakeholder

“

My son came home with the “new math” and I was quick to find him a tutor in Cleveland. Open Door had amazing resources, it helped me help him.”

—Community Interviewee

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #2 - Case Study

The Tipping Point “Family” is a program organized to help families help themselves. It is organized as a way for parents and children in the San Francisco Bay Area to come together, decide what they stand for, and do good for others.

They use their connections across industries to provide grantees with the resources they need to grow and increase their impact in the fight against poverty.

Tipping Point Community Aggregator business models are those that up-level relevant options and make it easy for people to help those they care about.

Tipping Point is an innovative public-private-social transformation organization.

"We are data-driven and laser-focused on results. By investing and partnering with early childhood, education, housing, and employment programs, we are able to help break the cycle of poverty for thousands of people all across the San Francisco Bay Area. Tipping point “Family” (https://tippingpoint.org/wp-content/uploads/2018/12/ TP-Family-Book_online.pdf) is a book offered to families helping them develop a plan.

"Tipping Point is an organization that works to make sure everyone in our community has what they need: “We believe in a world where all babies get loving care, all kids go to stellar schools, all grown-ups get good jobs and all people have homes.”

We are a group of people—teachers and coaches, doctors and lawyers, givers and "doers, and strivers and movers—who come together to support one another. But we can’t do it alone! We need YOU. And your family too. Your family is your plucky band of comrades, your ragtag team of big hearts, your source of knowledge and power. It’s time to decide what you stand for and live it boldly in your words and actions."

Cutler Center: Design Research and Strategic Recommendations

Our Powers Combined is a work book to help families understand their unique mission in order to Focus on what is important as a group This book will help families come up with their mission through discussion prompts and specific ideas for getting involved in their community.

GET BOOK

Tipping Point Stickers are the badge that shows the public commitment and a visual cue to the community GET STICKERS

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03. FINDINGS

Insight #3 Co-create an action plan building mutual empathy and include a unique profile of strengths, feelings, and physical state.

Supporting the Authentic Self Motivation happens when encouragement and self-esteem building are part of the conversation.

Some men changed providers or felt deterred from seeing a provider because they felt judged, misunderstood, or were not seen as a whole human. Many who spoke of wanting to talk more wanted to have self-esteem building conversation.

Communicate the value of being able to see the unique in each person.

Move from a silo of “diagnosis of what’s wrong.”

“ “

Everything was linked to me being overweight.”

—Community Interviewee

I needed my AIDS prevention drugs and was sent to the infectious disease department because the doctor didn’t know about my drug. This felt uncomfortable.”

—Community Interviewee

36%

71 are at least somewhat uncomfortable visiting a doctor because they fear they might find something wrong.

27%

53 are at least somewhat comfortable sharing information about their lifestyle with their doctor.

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #3 - Literature Review

José-Vicente Bonet, an expert and author on self-esteem, claims that, "the importance of self-esteem is obvious as a lack of self-esteem is, he says, not a loss of esteem from others, but self-rejection. Bonet claims that this corresponds to major depressive disorder."

Abraham Maslow It may be impossible to achieve wellbeing without self-esteem.

"Abraham Maslow states that psychological health is not possible unless the essential core of the person is fundamentally accepted, loved and respected by others and by her or himself. Self-esteem allows people to face life with more confidence, benevolence, and optimism, and thus easily reach their goals and self-actualize.

"Self-esteem may make people convinced they deserve happiness. Understanding this is fundamental, and universally beneficial, since the development of positive self-esteem increases the capacity to treat other people with respect, benevolence and goodwill, thus favoring rich interpersonal relationships and avoiding destructive ones."

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03. FINDINGS

Insight #4

Build diverse representation among staff, new navigator roles, and care providers.

Enlist a community advisory board.

Community Advantage Collaborating with community influencers enhances value creation, leading to authentic support for patients of color who comprise a large part of the UH patient base.

Consider adding men to the community health worker staff.

Enlist community to weigh in on messaging and outreach strategies.

“

Encouraging people to exercise if they have barriers that impede physical activity won’t work. Community residents can help with message development and identifying barriers, engagement approach, and policy change.”

—CEO of the Healthy Equity Initiative

We can learn more about opportunities for equity-based support by incorporating best practices and public health data as a call to action.

“

…With Obama it now is possible to be smart and cool at the same damn time.”

“

There needs to be people of color reflected, this gives and literally shows the young men you are trying to help by providing exposure to black people and people of color.

—Ta-Nehisi Coates

They need to see examples of men who are comfortable and in themselves and breaking down what it means to be a man. Show strong men who are vulnerable and cry and love their children and their wives."

Questions

—Community Interviewee Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #4 - Creative Inspiration

“

Building Communities

The participants, who are recruited from the same community as your patient population, can provide valuable insight into the underlying dynamics of certain disparities. These complex issues include cultural beliefs and values that can inform critical aspects of intervention design, as well as patients’ perspectives of healthcare delivery in your organization. Your [Community Advisory Board] can help maximize the chances that your equity-focused quality improvement interventions will succeed."

—The National Mental Health Association

Hire community staff and volunteers using language and event design that works for the people by the people.

Some examples: Harley Davidson, which has created more than 1,400 local chapters around the world for enthusiasts to get together in person and discuss their bikes; Fitbit, which has a community of more than 25 million members, who share and refine their exercise regimes; and HITRECORD, which has brought more than 750,000 artists, writers, and filmmakers together to collaborate on productions, many of which have shown at Sundance.

In another example, Bernie Sanders enjoyed overwhelming electoral support from Latino voters, particularly in states with large Latino populations such as California, Texas, and Nevada. Even in states with relatively small Latino populations, such as Iowa, he did extraordinarily well in Spanish-language caucuses.

“

He’s traveled around the country for the last four years listening to young immigrants talk about the struggles that they’ve had of traveling across the desert, risking their lives with their families, to come to a place that has a president that demagogues them, that treats them like second-class citizens.

It’s really moved him in some of the most emotional ways I’ve ever seen Bernie Sanders react.”

—Chuck Rocha, senior advisor to the Sanders campaign

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03. FINDINGS

Insight #5 Lead by expressing the long-term health commitment as central to the health relationship and core to the value proposition.

The Impact of Commitment

A commitment exercise incorporating actions of small, achievable steps could be presented as a “commitment challenge.”

Offering a lifelong commitment could be a game-changer for men.

Knowing the provider is committed was described as something that would enhance rapport and lead to greater accountability and willingness to participate.

“

The act of commitment between the provider, the patient, and even as a public badge ("I Voted" sticker)

Help patients accept what is out of their control, and commit instead to actions that enrich their lives (Harris, 2013)… actions that will assist in their long-term goals and living a life consistent with their values. Positive behavior changes cannot occur without awareness of how a given behavior affects us.”

—Stephan C. Hayes, clinical psychologist and Founder of Acceptance and Commitment Therapy

impact self-motivated change.

“

When you know the relationship is going to last for a while it changes it from just a doctor-patient dynamic. You are more comfortable and put more effort in, you build rapport and it is easier.”

—Community Interviewee

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #5 - Creative Inspiration

#CSLPlasmaChallenge Acting on the value proposition to share how the organization is committed can draw others in, and encouraging a mutual exchange heightens the emotional connection.

Cutler Center: Design Research and Strategic Recommendations

In the Plasma Challenge, those who donate plasma are showing their appreciation for the commitment made by front line workers. This campaign is unique because the commitment of the workers is blended with gratitude of the donors. The donors get a badge of recognition to post on social media, allowing them to more publicly share their gratitude of the front line workers. The badge also shows their social media community that they have participated, encouraging further donation.

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03. FINDINGS

Insight #6 Map women's health experiences over a lifetime to model a vision for a desirable men's experience.

Women Have More Options

Communicate the focus on enhancing the day-to-day as well as physical needs for men.

Women are more likely to seek care because, in part, there are more relevant and more interesting options for women.

The men we spoke to – in particular, single fathers – were disappointed they did not have the support their partners were

“

When we went to visit the doctor for post postpartum they never looked at me and asked how I was feeling.”

“

I am a single dad, we care for the children equally but if anything were to happen to their mom, the kids would go to her parents.”

receiving. Women have a variety of options to receive meaningful and relational care, including with family planning that starts at a young age. Lifestyle services that enable men to express their true feelings are desired but dramatically limited.

–Community Interviewee

–Community Interviewee

“

You should see what my sisters get, they have all kinds of options that I don’t have around support, they even get free furniture.”

–Community Interviewee

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #6 - Creative Inspiration

The Book of Man Lifestyle options/offerings such as vulnerable meetups, enhanced self-care, and simply gathering to talk are all opportunities for men.

“

A lifestyle brand is a company that markets its products or services to embody the interests, attitudes, and opinions of a group or a culture. Lifestyle brands seek to inspire, guide, and motivate people, with the goal of their products contributing to the definition of the consumer’s way of life. A lifestyle brand is an ideology created by a particular organizations’ brand (Schmitt, 2012) —Bernd Schmitt, author of "The consumer psychology of brands" (2012)

"So what is The Book of Man? "It’s a support network for offering advice and inspiration to modern men in a time of great change.

"There’s no doubt about it: something is going wrong for men. Look at the symptoms: rising depression, addiction, violence, violent death through suicide. Old school male dominated society is not just damaging to women, it’s damaging to men too. The archetypes passed through generations still dog us, drag us down – you know the ones, those of breadwinner/stoic/narcissist/rationalist/aggressor. The ones still exemplified by some of the most powerful man in the planet. But rather than giving it all The Shrug Off and getting back to Netflix, we want to make sure we’re doing something about it."

A campaign bringing awareness to the power of men being vulnerable with each other– something women are encouraged to do more often. https://thebookofman.com/mind/mental-health/the-campaign-against-suicide/

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03. FINDINGS

Insight #7 Curate content on social media channels with linkages between

Public Health Call to Action

physical and emotional health – take patients through a behavior-

Providing public health data that links anxiety reduction to a reduction in physical ailments in order to provide an opening for new comprehensive service offerings, which might otherwise feel out of place.

Showing the data and the physical to emotional linkages will

change-model, stepped process; Tailor for need levels.

strengthen the willingness to participate.

Some stakeholders at UH were concerned that offering advice on things like financial strategies was out of scope for the Cutler Center.

We asked participants whether introducing financial advice, by contextualizing it via public health data that links daily stresses and poor physical outcomes, would make sense. Participants want

“

Health education based on behavioral change theories can relieve symptoms of chronic heart failure and improve patients’ self-efficacy level, self-management ability and patient satisfaction.”

—Iranian Journal of Public Health NIH 2019

logistics advice to come from people who understand them and are experts in the recommendations they are sharing.

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #7 - Creative Inspiration

Consider separating the reasons to care for the Center from the reasons why men will participate – focus the call to action on why men should care and join. For the HIV prevention

H I V Campaign There are two main purposes of “a call to action:” to tell someone what they should do, and give them the motivation to do so.

program, the government wanted tests, while the patients wanted to know they were virus-free and their anger at HIV.

Public campaign calling on patients to be tested for HIV

Combining a commitment, a visual badge, and a message of altruism can be simple and powerful. Also the goal of the organization may be different than the reason for patients/community members will care.

For example, on #WorldAidsDay, MTV ran this campaign to encourage young people to get tested for HIV – they wanted to make this topic relevant again. Their clever campaign encouraged people to change the finger they usually get tested on and share it. They had 1.2 million impressions in 5 hours and became the number one trending topic in nine minutes! Even better, "Tested" was the most used word on the day.

And… to give HIV the finger.

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03. FINDINGS

Insight #8 Create forums at unique locations in communities as an extension of the Cutler center -tele-health, libraries, barber

Beyond the Office Offer ubiquitous care any time, anywhere, not just at the doctor's office.

The office sets the tone for serious conversations, but this also is a barrier for men who feel they can’t open up in the formal

shops, basketball courts, and parks.

“

environment. Many welcomed the opportunity to be in spaces that are more welcoming. Further, today with

—CEO WeWork

COVID-19, there is a new and important deterrent when thinking of a doctor visit.

We are looking to move people from meeting to connecting.

“Meeting” someone entails making small talk; it’s transactional and draining. “Connecting,” on the other hand, is getting to a deeper level; it’s telling stories, sharing acts of kindness, laughing, bonding over a common purpose, and learning people’s backstories.”

“

I was raised to think about things and regulate and solve problems. I feel like a machine, I am so mental that I need to be more social and physical. I would like to have more social skills.

I tend to focus on career, I realize sometimes my social connections could be more rich” —Community Interviewee

“

Questions Cutler Center: Design Research and Strategic Recommendations

[I’ve grown up online] I would like someone to help me with ‘social communication’” —Community Interviewee 27

03. FINDINGS Create a web of men to care for each other. All men need is permission, direction and a place to practice.

Insight #8 - Partnerships

EVRYMAN The impact of space and place is shown to be reflected in behavior. Spaces of privilege can be intimidating.

“

We can’t change what life brings. We can change how we respond. The world is asking us to do what it takes to promote health and safety in our society by starting with ourselves. I believe what the world needs for men today: learn and practice, and accept how to be vulnerable."

—Dan Doty founder of Evryman

Vulnerability + time equals depth of connection

Some medical innovations such as recreational therapists can play a role for patients' treatment. They utilize a wide range of activities and community-based interventions and techniques to improve the physical, cognitive, emotional, and social needs of their clients.

There are also new men's movements such as EVRYMAN. "The movement is not about “finding yourself,” but “creating yourself” – understanding and acting productively on your emotions instead of burying or redirecting them, and thereby building a more fulfilling life. With the need for safe distancing, our online program gives you what you need now more than ever. It’s an interactive behavioral curriculum, not therapy or guru worship, and we invite you to experience it for yourself."

Mens camp as a part of the Evryman series Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #9 Cutler could provide resources and be a connector, linking men to programs that already exist and other patients. For social media,

Pathways for Connection

Cutler could feature a mentor each week on YouTube in a "How To"/ “Maverick” style video.

Create pathways leading to relevant meaningful moments leading to relationship There are resources from community organizations, but patients themselves could be a resource. We talked to men who are experts in the arts, finance, and the trades who all expressed wanting to be a mentor. Patients expressed feeling enhanced self-

“

I would like to talk to someone who has been around and knows people like who could help me get corporate gigs and how to negotiate and connect with - you should never stop learning. I want to find connections through a friend of a friend.”

—Community Interviewee

esteem when helping others.

“

I want someone to talk to about ideas that’s not judgmental where I can get support building self esteem, or just venting” —Community Interviewee

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Partner with influencers, not just organizations, who align with the mission and can spread the word.

Insight #9 - Partnerships

Mentoring.Org "Mentorship" is a formal way of saying you're there for and supporting each other and that someone has your back.

Mentorship connections can be at all ages and assure support to reinforce that people are not alone in dealing with day-to-day challenges– it makes them feel like they matter. Research confirms that quality mentoring relationships have powerful positive effects on young people in a variety of personal, academic, and professional situations.

Self-esteem and the feeling of belonging is linked to physical wellbeing.

“

My advice is you can do something. You don’t have to be rich, you don’t have to be famous. As long as you have breath, hands, even a smile, a joke, anything can brighten someone’s day.”

–Ricky Smith, Founder of Everyday Hero Cleveland

R.A.K.E.’s mission is simple: To support the community in a positive way.

"We want to enrich lives, encourage kindness, and promote the act of “paying it forward.”

Every act of kindness, whether helping provide necessities to someone in need or promoting cultural growth among children, can help make a difference in Cleveland."

https://www.mentoring.org/why-mentoring/mentoring-stories/

http://www.rakenow.org/home Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Insight #10 Develop a needs assessment strategy that’s transformative and includes access to resources based on need level and context.

Tailor for Need

Develop a hybrid staff role: social worker, advocate, navigator, and coach.

Correlate “need levels,” physical health issues, and emotional support so they are relational and customized to patient context.

Two men may be struggling with stress leading to the same physical outcome, one may be having a hard time because he is food insecure, the other may have an allergy.

“

I put my students together and watch them to see who the leaders are, what their triggers are and how they approach situations, this helps me know where they need more attention.”

—8th grade teacher and community interviewee

The type of physical outcome may be similar, but the circumstances leading to the condition and the approach to treatment is different.

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

A multi-prong approach to understanding need will be supported by community members that are out in the community and can give

Insight #10 - Partnerships

Honor Care Network Partnerships like Honor Care Network can help you build understanding of patients' levels of need and context.

relevant context to patient situations.

“

We provide the amazing client care while Honor takes on the operations.”

—Scott Stanley, Caring Hands Caregivers, California

"Honor Care Network partners with top local health providers to deliver high-touch care on a national scale. We’re also forming partnerships with health system providers, payers, and other organizations along the care continuum. Together, we’re building a first-of-its-kind national network to support better, more reliable home care."

"I have been a caregiver since 2014.

Now with Honor, I just open the app to quickly share notes with family members, look at my schedule, and prepare for my visit."

https://www.joinhonor.com/care-network/how-it-works

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03. FINDINGS

Insight #11 Expand upon the concept of the idealized support offered by a “family of men.” Work with existing programs to help start the

Contextual Advice As life stage changes, so does the type of role models and advice.

conversation about physical health linkages with community health workers. Connect men of different age groups: a 22 year old could be a support to an elder; an adult man could step in for a 22 year old who could use fatherly advice. The support will go both ways.

We heard that over the course of life stages and at points of transition, unique supports were provided by fathers, teachers, coaches, brothers, and friends. For example: a teen learning about choosing friends; young adults and intimacy; parenting advice; or taking care of an aging parent.

“

I have yet to meet someone of my father’s caliber. His willingness to walk with me and invest in me and make sure I was protected. Looking back I realize that I am a leader and I can pour this back to the youth. Kids who are struggling might not even realize that they are dealing with struggles. The leaders can help guide.”

—Community Interviewee

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

The Cutler Center can develop and an expertise in understanding

Insight #11 - Benchmarking

the complexity of situational support and offer relevant, expert advice tailored to one's life stage, including niche experts.

Contextual Advice Physical ailments can be complimented with relevant emotional services.

The new modes of pharmacologic therapy give healthcare practitioners an unprecedented opportunity to treat patients with erectile dysfunction (ED), an underreported condition.

“

Traditional medical education does not always prepare physicians to discuss sexuality in a clear and candid manner with their patients. Therefore, physicians do not often initiate discussions about the possibility of ED or about couples' issues of intimacy and overall sexual health."

–Marian E. Dunn, PhD, author in the Journal of the American Osteopathic Association (2004)

"It’s about being receptive, willing, open, and responsive - we look at male sexuality in one way and define men in one way. Learning behaviors can shift, I work with couples and help them unlock possibilities."

Primary care physicians are in a unique position to address sexual and relationship issues that exist between patients and their partners. The doctors can maximize the benefits of their position for their patients by integrating emotional support into their treatment.

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03. FINDINGS

Insight #12 Create a patient, staff, and partner journey to see where technology

Balancing Tech and Human Connection

could enhance a connection and support building rapport, tracking, gaming, context awareness, and empathy.

The 2020s may turn out to be the decade when digital technology reshapes the health system.

COVID-19 has driven many developments in the first months of 2020 as the digital health community continues to navigate how best to bolster classic public health measures.

Integrate opportunities for connection via:

• • •

Building Information and Communication Technology infrastructure Aggregating and analyzing data at scale Enabling the availability of virtual and/or

“

— Mitesh S. Patel, MD, Perelman School of Medicine, University of Pennsylvania

Focus on patients' needs: • To feel supported • For anxiety relief

•

Improve care team response by reducing barriers to communication access

AI-powered healthcare services.

We have seen behaviorally designed gamification lead to sustained behavior change in other studies, a new randomized study of more than 600 overweight and obese adults indicates that adding a competitive element gives the best results”

“

My sister and I introduced our dad to fit bit, he now uses it with my nephew, they compete with each other. My dad likes it because he can talk with us about it - I am not sure he would like it if he didn’t have anyone to talk to about it.”

—Community Interviewee

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Platform thinking starts with a foundation of core services, then it expands to multiple touch points for communications, in a variety of

Insight #12 - Case Study

Curable Platform Curable Health is an online psychology program that teaches people to “de-program pain.”

learning contexts, focused on exercises, education, and transactions.

“

The Curable App, along with the companion "Like Mind, Like Body" podcast, have been a cornerstone in the treatment of my ongoing chronic pain symptoms."

—Curable testimonial

Curable is the first app to deliver evidence-based methods for chronic pain self-care. The Curable app guides users through easy-to-understand pain

"The biopsychosocial' approach to pain has shown significant results across clinical studies. Curable's unique design translates this approach for people, to help address pain from multiple angles - physical, emotional, and psychological.

science education, and hundreds of exercises designed to break the cycle of pain.

"The entire program takes place online via a personal computer, tablet device, or smartphone and is delivered via a virtual pain coach named Clara. You have 24/7 direct email access to the Curable team for any and all questions you may have. Via the podcast we learn about the science and hear personal stories of transformation."

https://www.curablehealth.com/science

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03. FINDINGS

Insight #13

Start Early Supporting boys, as early as middle schoolage, could be the smartest way to have lifelong support and the biggest impact on their lives.

Several men and internal stakeholders spoke about the need

for kids to receive advice and emotional support, and they highlighted middle school as a life stage when kids have the most sensitive “need levels.”

Rainbow Babies is a key entry point for both fathers and boys. If the Cutler program is focused on 18-45 year olds, consider ways this target audience could support those in the higher need categories like youth and the elderly. Help link community organizations with youth, particularly those from more vulnerable populations.

“

The hand off between the pediatrics and the adult side– that's a big drop area...[we should think] about the well baby visits and how to continue continuity of care from that moment on, instead of having it drop off."

—UH Chairman of the Department of Urology

Questions Cutler Center: Design Research and Strategic Recommendations

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03. FINDINGS

Build on the success of others who have created tailored, multidisciplinary care, like the work of Nadine Burke.

Insight #13 - Case Study

New Provider Model Focus on ACEs Emotional health is impacted by our stress response and is magnified at an early age and impacts all walks of life.

“

The original ACEs study was done with a 70% Caucasian and 70% educated population. If I were to ask how many people in this room had a family member who suffered from mental illness or drank too much or believed in 'if you spare the rod, you spoil the child'...it affects us all. We have a multidisciplinary treatment that works to reduce the dose of adversity and treat symptoms using best practices, including home visits, care coordination, mental healthcare, nutrition, holistic interventions, and medication when necessary."

—Nadine Burke

ACEs (Adverse Childhood Experiences) link emotion, context and physical outcomes.

If you are exposed to a stressful or traumatic events repeatedly, you're more likely to develop heart disease or cancer. The hypothalamic–pituitary–adrenal axis, the brain's and body's stress response system, governs our fight-or-flight response.

Children are especially sensitive to this repeated stress activation because their brains and bodies are just developing. High doses of adversity not only affect brain structure and function, they affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed.

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04.

Learning from Analogous Examples Blending our experience data and analogous research

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Building from the ground up

04. LEARNING FROM ANALOGOUS EXAMPLES

#1: Staff as the Brand OBSERVATIONS

Communications

Patient Experience

Operations

There is an existing audience in place.

Successful organizations with movements have staff as customers and evangelizers through a call to action.

New patients are introduced to the Cutler Center by relevant UH staff who head home and spread the word.

UH Staff are introduced to the mission and invited to contribute to the development of the service– the Center is super charged with a collective mission.

The 20,000 UH staff members are comprised of people from all walks of life – men and women.

Leadership of the Cutler Center are trusted and inspirational to the UH staff, setting the groundwork for evangelizing.

Interviewees want to connect to new experiences through friends and those they are referred to. UH staff are the 'friends who tell friends.'

The current cultural moment is to support frontline workers.

This is a unique opportunity to build on the staff as part of the narrative and the community of the Center.

Analogous example: Code For America "No one is coming. It's up to us."

This values statement drives energy for the cause outward to the public and national volunteers, creating the civic movement to better government.

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A matchmaking connector to meaningful resources

04. LEARNING FROM ANALOGOUS EXAMPLES

#2: Curated Connections OBSERVATIONS

Communications

Patient Experience

Operations

Patients we spoke with value the recommendation and support in their communities.

Share the impact of emotional burden on physical health, but also present the Center as a comprehensive resource connector.

Build on the “one stop shop” concept to include physical care and connections to resources at the community level in a safe space hosting partners and patients.

Develop a non-financial, cross-disciplinary, dynamic relationship with partners focused on mutual support.

The doctor cannot provide all non-clinical services, so partnerships are key.

Programs already exist in Cleveland providing non-clinical services.

Resourcefulness is about making relevant connections with new partners outside of UH.

A community created around men’s wellbeing.

Recognizing risk, the Cutler Center does not have to take ultimate responsibility for the output of the connection, however, vetting is a primary task. The value is making the connection and continuing to provide support, not solutions.

Analogous example: The Gates Foundation “We don’t just give grants, we build relationships. Bringing partners together to form their own alliances, we make introductions and support what organically happens.”

They work with partners that can help to affect change globally and scale solutions locally.

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04. LEARNING FROM ANALOGOUS EXAMPLES

#3: Offering Ease and a Customized Approach OBSERVATIONS Men spoke of needing support at different points in their life stages which include:

• • • •

Food Relational emotional support Advice Training

There are similar types of needs but different need levels.

A custom experience providing relevant resources and education

Communications

Patient Experience

Operations

Innovations in the community through social contests focused on having the most impact on a particular service category.

Balance the administrative need for a business case with a strong position on prioritizing various need levels.

Develop a prioritization strategy to truly and authentically operationalize needs assessments.

Strategies can include unique approaches to linking resources to individuals while keeping dignity at the center.

Map this to zip code/physical health needs.

Social contests bring a unique ownership to the participation of discussion and information sharing.

Pilot a program prioritizing service strategies aligned with social determinants and statistical health outcomes.

The type of mentor and life stage are also unique to each individual.

Analogous example: California Closets Providing options at all budget levels, designers come to the home and learn what is important to the customer consultants works one-on-one with customers to create individually designed solutions that work specifically for their lifestyles.

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05.

Opportunity Areas The future

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05.OPPORTUNITY AREAS

Learn and Iterate The following pages include a selection of ideas from interviewees, stakeholders, and the Wondros team.

Pilots enable true customer involvement.

When you ask them, customers will say one thing and do something else. The same goes for staff.

Market Viability

Customer Experience

Pilot Impact on Organization

When you run a real service at small scale, you can observe actual behavior, see the results, and engage with customers and staff about their experience.

Pilots enable customer involvement beyond voicing their opinions through surveys, observations, and workshops.

Economic Value

They let you both understand and measure what really means something in the everyday life of customers and staff.

We recommend piloting the following opportunities, many of which work in concert. We would like to work with you to create a pilot plan.

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05.OPPORTUNITY AREAS

Quick Wins

“Being addicted eats at your soul, that is a need the Center could fill because it is the kind of thing you can’t take on alone.”

“What if the Center had a garden and the food grown went to the farmers market with a Cutler Mens table”

- Community interviewee

- Community interviewee

FOLLOW AVAILABLE DATA Compare barriers to access based on zip code and patient data to inform logistical strategies, such as transportation. Use a new lens on available data to correlate opportunities for the removal of logistical barriers

BROADEN THE “CARE CONVERSATION” Working with a key offering to be resourceful, help men be helpful at their homes and to take care of their sphere of influence: partners, kids, friends, parents.

RESPOND TO LOCAL PUBLIC HEALTH CRISIS IN A TARGETED, MEMBER-ORIENTED WAY Transform care so that it will have direct impact on Cleveland men. Each year have a Cutler Impact Area mobilizing the membership to “take on” a seeming intractable problem using a Human Centered Design framework as a foundation to build a nationally recognized "Cutler Change" strategy. Start with a baseline, archive the process, and develop a toolkit to help other institutions and cities replicate the program.

CURATE GROUP VISITS Conduct group visits via facilitated video visits. Patients will be invited to discuss scenarios and respond to challenges. Providers will learn more about their patients while bonds are formed.

LOCAL SUPPORT Create a Community Advisory Board action plan developed by reviewing and analyzing best practices and strategies to inform the framework for a targeted feedback loop

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05.OPPORTUNITY AREAS

Tools & Roles

“I have a patient I operated on, he’s certified and willing to help other patients go through it all. I can tell them what the recovery is like, but he lived it.”

"My patients daughter said her aunt could not come to the doctor because she can’t walk down the steps. The community health person would know who in the neighborhood could come over and build the ramp without a big cost.”

- UH Stakeholder

- UH Stakeholder

DIGITAL HEALTH

MAPPING AND PLANNING

NEW STAFF ROLES

Build a strategy that has targeted digital health plan rather than choosing a set of one-offs.

Audit the patient experience to help providers and staff reframe systemic communications that might be perceived as judgmental. Target systems designed for effi ciency to fi nd areas where sensitivity has been inadvertently lost.

Navigators for insurance, fi nancial programs, second opinions and access to the right provider. Navigators can help coordinate care team collaboration.

Resist the allure to take on apps with “walled gardens,” and instead incorporate inspiration to formulate a platform. Work with partners who use open code, making it easier to integrate partners.

Incorporate a feedback loop with patients via social media to enhance service experience, start a conversation, and share educational content.

Enhance GP referral experience as part of the “matchmaking” effort, helping patients build the care team that is right for them.

Utilize a tele-room at the library so folks who have limited tech access can still receive care via video visits. Establish a baseline of metrics to which impact can be measured against.

Cutler Center: Design Research and Strategic Recommendations

Patient action plan that highlights resources unique to them as part of their EMR. Lifestage pattern maps that highlight, distill, and organize services over time. Some services may be relevant to situations that apply to all walks of life, like pain management or substance abuse, as compared to contextual care related to age, like cognitive decline or puberty. Other patterns might include lifespan approach, such as the desire to reduce the affects of aging. All services would support the Cutler framework's lifelong care strategy.

Patient advocates can advise patients, take extra time to run through decision making, and help patients understand what’s next or what questions to ask. Advocates can also help inform the creation of technology and new process rollouts because they'll understand the nuance of patient experience.

Mentorship, at each stage of life as different transitions happen, will give members support from someone who knows what it is like to make those transitions and has sound, sage advice to help other members make better decisions.

An Experience Officer and digital health guru, like a “creative technologist,” on the strategy team will ensure the patient experience is private, useful, and desirable for the staff and the patients. This role can think more broadly across the platform from a service and data-oriented perspective.

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05.OPPORTUNITY AREAS

COMPREHENSIVE and ALL HEALTH Go Green in Racine is reinventing the neighborhood in Chicago with food at the center - it is a holistic approach to health including access to transportation, food, and possibility. Cleveland can borrow the roadmap!

Brand & Marketing

gogreenonracine.com/mission

COMMUNITY OUTREACH

EDU-TAINMENT

PARTNERS

Combine motivation, incentive, and commitments across community groups. Focus on a pipeline of African Amerian mentors and doctors. Invite several church and professional groups, e.g., Cleveland Professional Black Accountants hosting food competitions in the park with a scholarship for each category going to the winner's high school (or sports team, art department, or math club.)

Consider the process of supporting patients' efforts to have healthy relationships as part of their state of wellbeing and build this into a multi-prong effort.

Leverage others who have a similar mission. Create a public health campaign in partnership with larger entities like Health and Human Services who can feature Cutler as a partner.

Invite local community librarian to help incorporate nuanced language that will resonate with various communities who have unique needs

Develop an ongoing, co-branded media series focused on specifi c topics linking emotional impact with physical outcomes in a humorous way: podcast, videos, or full campaign.

Work with local farmers to create a series of “Victory Gardens� across the communities with limited fresh food. Sell produce at farmers markets with the Cutler brand to increase membership, feed the community, and educate on cooking. Local farmers become members in the Center and food cooperative, and activists for Cutler in both rural and urban communities.

Cutler Center: Design Research and Strategic Recommendations

Create a Call To Action focused on future health to help men understand the longterm implications of choices and decisions.

Invite local comedians to collaborate on a series of videos focused on debunking toxic masculinity and mind-body health in a playful way, sneaking in important public health information and myth-busting.

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05.OPPORTUNITY AREAS

Business Strategy

“The Center could have a philosophy; to be built on the principle of denormalizing dysfunction mental, physical, social or economically that should be a goal. Pay attention to disparities and have staff that represents multiple perspectives and lifestyles.”

“Our biggest payer is the federal government. If we want volume, we need to cater to those with limited resources.”

- UH Stakeholder

- Community interviewee

PLANT SEEDS EARLY TO SET AUTHENTIC EXPECTATIONS on life stage issues, like long-term disability– just one example of an important health support that few people know about. Start with young adults to plan and prepare early.

APPROACH TO OPERATIONS

Design a research plan helping providers understand the type of emotional support that would compliment physical conditions.

Recognize providers who have been trained to focus on the body, but who may not be the experts in illuminating a particular type of emotional support.

“Therapy could involve female partners - that would be huge, but the access isn’t there. I end up doing a lot of that basic therapy in my office. But I am not a therapist.” –UH Stakeholder

Cutler Center: Design Research and Strategic Recommendations

BUSINESS CASE Review model and service offerings to develop the financial model using strategic analysis of innovations in payments, such as price transparency and a menu of services that patients can discuss with advocates and select from.

The customer is not always the payer and multiple stakeholders have different goals and desired value exchanges that are frequently not financial. Research alternative value models.

BOARD OF ADVISERS/ COMMUNITY BOARD/ BOARD OF TRUSTEES “The makeup of the leadership should know where the pain is. The Board could be representational. Tap local people who are already doing that work to also give clout.”

–Community interviewee

Articulate a business case that includes both monetary and non-monetary value exchange, show the impact of transformative support models.

Build on under-reported, emotional impact data.

Incorporate the linkage of emotional and physical health into the business case and metrics, illustrating impact in ways that align with the mission of “comprehensive care," resulting in “comprehensive impact."

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05.OPPORTUNITY AREAS

Steps to the Pilot Plan and Rollout Wellbeing Facilitation Tool Kit, including behavior and lifestyle resource assessment

01

Community Partners /Collaborators

Calls to Action

Conduct specific service feature and potential partner research, supporting the ultimate Cutler experience and offering. Create the roadmap.

Health Topic Education

Cutler Center Service Experience Topics

02 Build a pilot program to prototype service features with community members in order to gather feedback, and build relationships and trust.

Innovative Community Outreach Plan

Mens Health Literacy: Awareness campaign app / Video Stories

Action plans, Road maps and Information Visualization Frameworks

03

GP and Care team referral

Convene a working group for input and feedback on the roadmap and framework.

Digital Health Plan

New Staffing Roles and Training Programs

Next steps Cutler Center: Design Research and Strategic Recommendations

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05.OPPORTUNITY AREAS

Opportunities for Further Research Behavioral Psychology and Gender

Culture

•

Better understand adult men’s friendships and social networks in order to design successful mentorship and peer support services

•

Better understand how COVID-19 is impacting the health needs and behaviors of Cleveland men

•

Review women's programs over life stage to potentially modify for male patients

•

Unpack successful movements that have lead to behavior change to develop the Cutler framework roadmap

•

Create a community and patient panel for research and innovation

Community Needs •

•

Deeper dive into the needs of Cleveland men in specific zip codes (perhaps building upon CHNA data) Identify community partners to build the Cutler Center’s resource network and partnership program

•

Develop patient registry and network focused on men’s health

•

Understand more about the type of visits frequented by men; acute urgent care, specialist visits, emergency room, general check-ups

Cutler Center: Design Research and Strategic Recommendations

Program development •

Develop new models for needs assessment and continue building out strategies informed by key findings

•

Create an experience journey to locate areas of opportunity for innovative programs and digital health

•

Develop a service blueprint

•

Create a life stage journey with transitions and supports highlighted to use as a plan for service development

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Thank You