Karin Karlsson – Design Thinking For Innovation                              January 7, 2021

Reflection – Mind Mapping

Challenge

I had only been working in my job for two months.  Getting to know the staff and their procedure was my first  goal.  I have been an adult day program director for 28 years, opening two and rebuilding one.  I was now at an  established adult day program that just needed some new breath of air.  I was in the mist of a meeting with two of  my lead team members when we heard two loud crashes.  As we walked out of the office to investigate, we found  two of our main windows broken and one of the staff standing in front of a client who was holding a hand weight  ready to throw.  We were able to gain control by de-escalating the situation that one of my leads and myself knew  how to do.  We were lucky that no one was hurt.  Afterwards we investigated and filled out the proper licensing  forms for the incident.  I kept thinking about what happen and why.  I then realized that we had two vastly  different populations in our program.  Elderly dementia clients (for which we are designed to server), and younger  behavioral clients (easy money that the budget depends on now).  The handling of these two populations in  situations are totally different.  Staff would be required to know and respond at any given moment.  Yet the staff  was only trained for dementia clients.  But if we change back to dementia as we were designed to be, financially  could we keep our doors open?  Why would anyone want to come to our program?

Selection

Then one day, I was at a conference and a fellow adult day program director came over to me and asked: “Why are  you known with the doctors and clinics as being the best adult day program in Frontal Lobe Disease”?   I did not  know we were (but I did not tell her that).  And then that got me to thinking, this may be an opportunity to  capitalize on!  I needed to research more the “What is” in our program.  Looking at why our clients chose to come  to our program I started with the mind mapping approach.

Application

Mind mapping is looking for patterns and insights.  Therefore, we started to explore.  First, I needed to identify the  stakeholders:  Clients (who have the disease), their caregivers, the doctors/clinics)and staff.  Second why chose our  program above other programs? Because the client does not necessary want to come.  The doctors/clinics refer,  and the caregiver chooses.

Starting with identifying clients with Front Lobe Disease and then corresponding them with their caregivers and  doctor offices.  Almost all our dementia clients had Front Lobe Disease.  Divided the list with the lead team we  started to do ethnographic interviews.  Caregivers were the most talkative and we let them run the conversation.  I  called the doctors and clinics to see why they referred their patients to us.    The findings presented more  questions.  To dig deeper by direct observation, I spent a day in the program as if I was a client.  I then went to  other day programs to see how they were run.  Staff was given a game to play…Why you work here?  They were  asked to describe a situation that sums up why they work here. With all these findings we developed a Mind  Board.  Columns were drawn for each stakeholder group as well as programs visited.  Sticky notes were used with  comments and observations.

Insight

As the mind mapping developed, I found that there were several emotional as well as practical reasons why our  program was selected.  These patterns were highlighted.

For the client:  They felt that they were with friends who understood them and let them be themselves.  They

did not need to worry if they were right or wrong – they were accepted.  They also had a purpose in life again, a  reason to get up in the morning and go to bed at night.  They laughed and had fun.  The staff “care” and help them  kindly when mistakes were done.  For the Caregiver:  the facility was homelike, clean, and comfortable.  The staff  was very warm and kind, deeply knowledgeable and would bend over backward to help.  The staff walked with  them through this terrible journey and they felt that their loved one was safe.  For the Doctors and Clinics:   Caregivers and clients told how much they liked the program and how much better they were.  Doctors noticed  better attention span and engagement in conversations from clients.  Caregivers seem to be getting rest.  For staff:  it was very emotional.  Their stories shared were how they made a difference for someone.  That this was the first  “mission” they truly understood and proud to be partner with.  This was the best job they ever had.

There were observations in visits and interviews that also stood out.  In the other programs observed there was a  clear difference in the way staff approached clients and worked with them.  The facilities were more institutional  and colder.  The activities, although structured were large and few.  Clients were seated in areas without clear view  of activity at times. TV and sleep time seemed to be encouraged.  Behaviors were more obvious and frequent.   Staff was paid higher wages with more benefits. High turnover.

Our program spent more time in activities that were designed for their individual needs.  Routine was especially  important including individual restroom time schedule.  In activities they were faced in front with limited  distractions and smaller groups.  Exercise was two to three times a day (yoga, large group, volleyball, stretching,  small group), where they could choose or encourage.  There was no down time because staff always were ready  with another activity.  If the client needed to rest, they could, but was encouraged to participate.  Staff watch and  anticipated behaviors, ready to respond.  Staff also was very gentle and sympathetic towards the clients – Helping  rather than doing.  They were there for a purpose – to be themselves.  Staff was lowest paid in area with good  benefits.  Lower turn over.

These findings were amazing.  But the biggest driving force behind their choice was from a support group  downtown and local churches.  It was from caregivers who use the services and by word of mouth suggested us.   The facilitator of the support group would report this in their routine meetings with doctors and clinics.  The  churches would talk between each other and referred by pastors/priests/ parish nurses through conversations  with their caregivers.  A caregiver has so much guilt and fear of “handing” over their love one to someone else to  care for.  And they wanted to hear from people they trust.  They are relentless in finding the perfect place.  And  here we were.  The biggest finding was our own caregivers!  Word of mouth was our marketing tool for this  population.

Approach

Before this tool was used, previous directors used hutches and assumptions.  They based the program on the rates  and basically anyone who wanted to come to keep their attendance up.  They had long ago forgot their direction.   Through Mind Mapping it showed “why” clients come and what motivated their caregiver to choose us.  How  doctors and clinics knew about us.  Why our employees stay with us at low pay.  The breath of air we needed was  Mind Mapping to open What if?  Specialized day programs are hard to find, but what this has showed that there  may be an opportunity.

