Health at a Navigation Center for Homelessness

Process

I was introduced to the organization Healthcare in Action (HiA), a medical group trying to expand street medicine to serve people experiencing homelessness, at a time when HiA was growing quickly. This included expanding to be the primary health provider for a new 240-bed navigation center for people experiencing homelessness in San Mateo, CA.

Building a Design Sprint

I was intrigued because they are one of the few organizations trying to scale street medicine, so I decided to work with the HiA leadership to bring a human-centered design lens to prepare for their San Mateo launch. Their existing teams were in Southern California, so this would be their first Northern California location. Because a design question can be hard to isolate when you're building an entire operation from scratch, we used a design sprint to clarify HiA goals, paint the existing health landscape, and identify opportunity areas.

Aligning the Mission and Metrics

The design sprint involved different stakeholders from HiA leadership, San Mateo County Health, the non-profit running the operations of the navigation center (LifeMoves), SCAN Health (the parent organization of HiA), and HiA team members who have been working on the street medicine care model in Los Angeles.

One challenge of taking on a problem as vast as health for people experiencing homelessness is that “success” may look different to different people. We used a goal setting workshop to clarify the organization’s goal, then came up with metrics that aligned with that goal to help HiA keep track of their target. Simple metrics often do not encapsulate the entire picture, but they provide a basis to capture progress. I met with collaborators and partners to get a sense of their goals and perspectives.

Starting Map

Before diving into design research with clients, we created a simplified map of what steps Healthcare in Action would need to take to help patients become housed and improve their health and quality of life. In reality, many of the "steps" would not be one-time services but rather recurrent services. We made a short list of the relevant people and organizations, both internal and external, and notated who would be involved in which steps. Although a complete map would involve many more pieces, this version was intentionally streamlined to keep the vision clear.

Primary Design Research in the Field

I then did field work in San Mateo. This involved both immersion and observation with the existing street team, tours at partner health organizations, and primary interviews with residents at the homeless shelter that was going to transition to the new navigation center. In these environments, I started learning about people’s experiences with homelessness and the existing health infrastructure. This was particularly intricate, as there was already a web of organizations and services that clients needed to navigate to meet their needs. While some barriers to health were logistical, others felt intertwined with deeper themes like identity and societal culture. I learned how health was related to their top priorities, if at all. I started to trace the local environment regarding mental health and substance use care.

Opportunities to Launch

We synthesized learnings from these interviews to jumpstart the launch and set the focus direction for the new San Mateo group. One observation was that small acts of support, like providing water or a deck of cards, were really meaningful to both staff and clients and often opened the door to greater change. But, this practice becomes pressure-tested quickly when staff are overworked, which can happen easily when demand exceeds capacity. This turned into an opportunity area to create early structures that encourage staff to maintain meaningful relationships with clients as HiA grows, pre-empting high demand and protecting acts of kindness by design.