For Elliot, a veteran who was weathering a difficult transition back to civilian life, it wasn’t just one problem that was holding him back. It was a combination of severe anxiety, money troubles, and failed plans that had left him feel hopeless. He began to  contemplate suicide when, he says, “all my plans from A to Z for my family just failed. I didn’t have a job. I didn’t know what I was going to do.” 

Elliot’s experiences and sentiments are intensely real—and yet, he doesn’t exist. At least, not as one individual veteran named Elliot. His profile is one of several “storylines” or composites drawn from dozens of personal interviews with real veterans, as part of a groundbreaking pilot project that used design thinking as a lens to address one of the nation’s most critical health issues. 

The pilot hinged on a close partnership between the CDC’s National Center for Injury Prevention (Injury Center) and the Lab at the Office of Personnel Management (OPM). From the outset, the partnership was designed to leverage each entity’s strengths in a structured, collaborative way. The Lab would bring the insightful, nimble tactics that are the hallmark of human-centered design, and the Injury Center would bring its deep subject area expertise. 

Kinzie Lee, Strategic Partnership Lead at the Injury Center, says: “[Human-centered design] aligns so well with what our mission is, in public health and government as a whole. We’re serving the American people. It’s important to make sure what we’re designing is something they want.” 

Building off past work, looking ahead

The Injury Center was able to build on a lot of past research on veteran suicide, at the CDC, at the VA, and across the many related efforts run by the private, public, and non-profit sectors. But working with the Lab at OPM would complement those efforts and tap into the potential of design thinking. 

Leah Chan, a team member and Public Health Advisor at the Injury Center, says one especially inspiring aspect was “the doors it opened for increased engagement…. It’s that deeper level of empathy… We can meet veterans where they are rather than where we think they should be.”

Throughout the year-long project, staff traveled to six communities around the U.S. In one-on-one interviews, they spoke with 46 veterans as well as veterans’ services organizations about what it meant to transition out of military service and where they continued to struggle—with a special focus on veterans younger than 35, who are less likely to reach out for services. 

“So often, we sit in conference rooms”

Unstructured, one-on-one conversations aren’t the norm at data-focused institutions such as the CDC. But the Lab at OPM was able to work with the Injury Center to think about these conversations in a new way: as “stakeholder discovery” that would help inform their thinking outside of the confines of traditional research and statistics. 

It wasn’t about getting massive numbers of respondents. It was about truly understanding and listening to the veterans who shared their (often deeply painful) lived experience. Chan participated in this field work and says, “I was incredibly humbled by the individuals we spoke with… So often, we sit in conference rooms, we work with different data sets, we’re all about being data-driven and evidence-based. But hearing those individual stories was a good reminder that behind every number is a person with wants, needs, and experiences.”

After months of candid interviews, the project team began clustering their findings and looking for patterns. From there, they created storylines—like Elliot’s—that reflect how real-world veterans are grappling with their transitions to civilian life. 

In the end, the team identified nine categories that affected veterans’ lives, everything from their sense of purpose and identity, to their ability to access care. 

Challenging assumptions and setting expectations

Through co-design workshops, veterans and Injury Center experts worked together to present design concepts for potential solutions, based on the identified themes. 

The workshops encouraged a different kind of perspective on public health. The approach of the Injury Center involves studying decades of data, but human-centered design encouraged “the opportunity for divergent thinking,” Lee says. “We heard from several subject matter experts [at the Injury Center] how amazing the opportunity was, to sit next to the people that had experienced this… We had many veterans [involved in the project] who had lost folks to suicide. A lot of what we thought would work or assumptions we’d made were challenged through this process.”

At the same time, it was important to define the limits of the process, says Lee: “When we’re working with very quantitatively focused scientists, it’s really important to define what human-centered design can do and what it’s not set up to do. For example, we’re not going into this to test a hypothesis. And we’re not going through these insights to get results that can be generalized to the entire U.S. population. But there is a ton of value in pairing all the data alongside that human perspective. “

In a report released internally in April, the team shared ten ideas for transformation with their broader team, particularly focused on reducing isolation and increasing access to care. (For a copy of the report, reach out to the Injury Center at inu4@cdc.gov.) The timing couldn’t be more critical, because suicide is a leading cause of death for Americans, and veterans face trauma and stresses that make them especially vulnerable. 

Changing how an organization thinks

Although these innovations are focused on veterans, the collaboration helped infuse the Injury Center with fresh strategies, as it continually seeks to solve some of the most complex problems facing the U.S. Chan says this organizational learning is the product of frequent, intentional  communication. Make your work visible, says Chan: “It’s incredibly important to cultivate champions at all levels, [in] leadership as well as a groundswell of support at the staff level. Show them the value of the human-centered approach.”

Lee says that storylines like Elliot’s, in particular, have sparked ongoing interest: “There was quite a bit of interest in…how we might utilize those types of storylines [to] focus a public health intervention. When you’re looking at a storyline, you can see all these points in which they touch a part of the system.”

A second year of the project is being planned, and next steps include iterating on some of the pilot projects that they’ve already identified. The first one involves helping veteran-serving organizations evaluate their programs. Chan says that new relationships with veteran-serving organizations has also been “an incredible return on investment for us. It’s really helped us accelerate the pace of our work.”

Lee says that the project has already paid off in more indirect ways, too. OPM and the Injury Center were able to open a truly productive dialogue with each other, built on mutual curiosity and respect, to develop and codify ways of working that are now repeatable. 

 “Human-centered design can be deployed in big ways to address sticky issues in public health, but it also can be applied in small ways to make a meeting better or engage a partner in a new way,” says Chan. “It’s making sure that we are putting people at the center of what we do.”