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Postal Networks & Community Resilience

Research, Strategy, Experiential Futures

As part of an elective class, myself and four team members developed a service concept for USPS that uses existing postal infrastructure to deliver diffuse light-touch care to rural populations. This concept hybridizes the role of mail carriers and community health workers – the former of which have regular long-term exposure and relationships with rural residents, and the latter of whom play a critical role in keeping vulnerable populations meaningfully connected to the health and social services that keep them well. We pitched our concept in an ‘experiential futures’ format at the inaugural Places & Postal forum where it was met with excitement and interest by USPS, urban innovators and healthcare experts.

Team | Ceda Verbakel & Carlie Guilfoile (project leads, design/futuring), Kat Sutherland (policy & healthcare), Xin Hui (architecture & urban innovation), Rachel Lee (designer)

Time frame | 10 weeks

 

1 | Walking Tour

We wanted to center our research on the postal domain as a nation-wide system, while at the same time, consider the place-based nature of how post office closures affect neighborhoods. Our exploratory research began with a walking tour of Homewood – a neighborhood in inner Pittsburgh that is still recovering from economic collapse – and who’s local post office had recently and unexpectedly closed.

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2 | Subject Matter Expert Interviews

We interviewed two people who understand the current state of USPS intimately. Steve Hutkins, a literature professor who teaches “place studies” and has maintained a thorough account of USPS changes and it’s economic and social ripple effects called Save The Post Office. David Williams served as the Inspector General for USPS for 13 years, and is now the Vice Chairman for the USPS Board of Governors.

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“If you close the post office, you don’t have a zip code – you kill the town.”

STEVE HUTKINS

Associate Professor at Gallatin School, NYU

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“USPS operates on a universal service obligation... and efficiencies of scale.”

DAVID WILLIAMS

Vice Chairman, USPS Board of Governors

The United States Postal Service is the largest postal network in the world, reaching every household across the United States, 6 days a week.

In recent years, USPS has been subject to policy changes and economic pressures that threaten its survival. The ability to innovate is stymied by the bureaucracy that comes with being a large-scale government organization, and at the same time, is treated as a financially independent organization that does not receive government funding.

An unprecedented government sanctioned mandate to prepay health benefits to future employees, and a nation-wide drop in letter delivery have led to mounting debt and post office closures in mostly rural areas that may need them most. To mediate this crisis, we asked ourselves:

How might USPS make use of existing infrastructure, achieve economic sustainability, and continue to fortify the communities they serve?

 

3 | Exploratory Ideation using the Postal Matrix

Once sufficiently steeped in domain knowledge, we used a “Postal Matrix” framework to begin a class-wide process of collaborative exploratory ideation, which listed postal system components on the x-axis (building facility, postal worker, mailbox, delivery vehicles etc) and possible domains of innovation on the y-axis that fell into 4 categories: people, planet, place and performance.

 

4 | Focused Ideation

After using the “Postal Matrix” framework to take stock of the breadth of possibilities that lie at the intersection of postal networks and community resilience, we shifted into a more focused mode of ideation using The Thing From The Future – a card game for imagining objects or artifacts from possible futures. The game involved pulling a single card from each “suit” (including the “thing” card, the “future” card, and the “theme” card) to produce a complete sentence prompt to come up with objects from preferred futures.

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Above are examples of some of the objects I came up with as part of the warm up rounds of play – our final prompt was “In a RESILIENT future there is a BUILDING related to HEALTH”, and we used postal networks as an overarching meta theme to guide ideation. As a group we collectively selected the idea which had the most promise – using underutilized post office buildings as vaccination clinics, and training postal workers to transmit up to date vaccine information and appointment scheduling. We felt that this was a timely response to recent anti-vaccination movements and sporadic virus outbreaks, and it seemed like a system as ubiquitous as the postal network could play a role in outreach and disseminating information. Our ideation session ended with a rapid prototyping role-play. We staged a 1-2 minute newscast from the future based on this concept.

 

5 | Prototyping Sprint

After the initial role-play exercise, we developed our idea as a team in preparation for presenting to the rest of the class. Based on further research we expanded our idea to include preventative healthcare, not just vaccinations, and our “MediPost” concept was born.

MediPost maximizes the wellbeing of our nation by providing hyper-local, efficient, and trusted preventative care services using the highly networked physical and social infrastructure of the USPS.

MediPost has a 2-tiered approach to achieve its mission. First, MediPost uses USPS infrastructure to deliver accurate and up-to-date information on preventive health to every community. Second, and driven only by local community need, the MediPost is made up of local hubs that deliver low-cost wellness visits.”

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We produced a rough service blueprint to support our own understanding of how the user’s experience and Mediposts operational activities might be mediated through specific touchpoints. We mocked up some of these touchpoints in the form of an introductory door hanger (below left) and an appointment setting postcard (below right).

Finally, we produced a very rough rendering of what a dual post office / health center hub might look and feel like, in order to tell a more convincing visual story of the future state service.

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6 | Evaluation

After presenting our Medipost pitch, we re-grouped as a team to reflect on what we learned before moving forward. We facilitated our reflection using Edward De Bono’s “Six Hats” parallel thinking tool.

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First, we shared gut instincts, intuitions and feelings (red hat), then we shared what was working (yellow hat), what wasn’t (black hat),what information we still needed (white hat), and then switched to generative thinking (green hat) to come up with next steps.

The “Six Hat” tool allowed us to focus and orient ourselves to main themes of research that we divided up amongst the team.

These included:
• Health and big data
• Pharmaceuticals and e-commerce delivery
• Insurance and funding streams
• Rural preventative health
• Place-based community fit

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7 | Evaluative Research

Two interviews with experts from the rural health domain stood out when we re-grouped to share our independent research. We learned how health care in America is increasingly becoming integrated with overall wellness by addressing social determinants of health, like access to transportation and family support.

A new model of care has been developed in response to this need, which employs community-based health care workers (CHWs) to outreach and connect individuals to care managers, who are mobile trained social workers with a focus on connecting clients to services that will ultimately improve their overall health and wellbeing. These needs range from housing, to substance use treatment, to food delivery, and more. While underutilized postal networks might lay the foundation for facilitating this model of networked care, it also ultimately needed to economically benefit USPS in some way.

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“The challenge is in how to pinpoint the highest risk and highest cost people.

We see the Care Manager as an intervention whose job it is to get [people on Medicaid] the services they need.”

Gina Lasky is a licensed psychologist with expertise in public sector behavioral health system design and programming including integration of behavioral health and primary care.

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“Community Health
Workers are recruited to work for their own communities. They’ve gone through training – protocols, communicating information in standardized way, and so on.”

Lisa Davis is the Director of the Pennsylvania Office of Rural Health and Outreach Associate Professor Health Policy and Administration at Penn State.

We spoke with Gina Lasky, an expert in health care management, who informed us about using medicaid as a possible funding stream. In this model, states who expanded medicaid would have money available for managed care companies to disperse so that healthcare providers can
be reimbursed for their services delivered to the medicaid population. Managed care companies are funding community health workers as health outreach workers.

We saw this as a potential reimbursement funding model for how the postal service might benefit from being facilitators of this service. The managed care company dollars could go towards paying those postal workers acting as community health care workers, pay for training costs, and perhaps subsidize the postal service building that would function as the care manager’s office.

When talking to Gina Lasky about our Medipost concept, she instantly spotted how existing postal infrastructure could be utilized to deploy the care manager and CHW model
to rural residents. She explained that while the CHW model was effective, it was still far from reaching everyone, and could see how postal infrastructure might be able to reach the millions of Americans who aren’t currently receiving the support they need.

Postal carriers could act as a diffuse system of light-touch care to the Medicaid population by reaching people who face barriers to access (like not knowing how to use insurance and healthcare systems), and have high risk needs. Postal service workers could be trained as community health workers, touch base with high risk populations, and coordinate with the care management side to better plan services.

 

8 | Critique & Iteration

We then prepped three storyboards to communicate our service concept to a guest critic in class: Bryan Boyer is the co-founder of Dash Marshall, a design and strategy firm that specializes in urban and civic design. Each story board told a unique user journey story from three rural resident personas based on our research – a young man struggling with addiction and mental health, new immigrant residents, and an older woman with a chronic condition.

 
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Storyboard 1 | Chronic illness maintenance support (diabetes example).

 
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Storyboard 2 | Recovery support and crisis monitoring (mental health example).

 
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Storyboard 3 | Outreach for Medicaid enrollment and preventative care (new immigrant family/immunization example).

 

We presenting these storyboards to Bryan, and he gave us insightful feedback that helped bridge missing gaps, and fine-tune our concept.

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We affinity mapped Bryan’s feedback into the following key takeaways:

• Perceptions of Trust & Government: The USPS is one of the most trusted brands across the United States. How might this partnership shift public perceptions of trust and government?

• Quality over Efficiency: How might we reframe the problem to USPS so that we highlight how slowing down and delivering more value to each home, is preferential to the usual mindset of delivering as fast as possible to as many homes as possible?

• Framing the Problem: How might we use cultural understandings and narratives around existing interactions and relationships that are organic versions of the interactions and relationships our model relies on between the postal worker and residents? (for example the local convenience store man being intimately in tune with the wellbeing of an elderly resident).

• Workforce Changes and Roll-out: How might the shift in workforce requirements be rolled out? How might we design and frame this shift to account for existing postal workers who might not be a good fit for CHWs? Are you retraining or recruiting new folks or both?

• Data: How might this model make use of data? How might this model find ways to stay connected to the wellbeing of residents through unusual or organic methods of data collection?

• Validating Funding Partnership: How do you validate this concept through the eyes of a funding partner?

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From here, the team integrated this feedback into our concept, and entered our final sprint in preparation for the inaugural Places & Postal Forum.

 

9 | Final Iteration & Presentation Planning

Our final concept combines mail delivery in rural regions with the community health worker model of preventative healthcare. To shift away from the perception of the service being medical, and toward a more holistic community care provider that builds on the established trustworthiness and reliability of USPS, we rebranded our intervention as USPS+.

In preparation for the inaugral Places & Postal Networks Forum, we decided as a team to present our concept as if it already exists from the year 2029. We came up with a list of different contexts we could stage (right), and eventually landed on the concept of a promotional pop-up booth in Greene County, Pennsylvania that celebrates USPS+ milestone of rolling out to it’s 500th county nationwide. The booth would double as a recruitment opportunity for local carriers to join the team.

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We sketched possible artifacts and uniforms that would accurately tell the story of USPS+ and thought carefully about how these tell the story of the service, and at the same time, anticipate and answer criticisms and questions of our intended audience, including professional stakeholders who work at USPS, or in the healthcare/civic innovation domains.

We then produced two informational materials – a promotional recruitment flyer (left) and a general information booklet that explains the USPS+ service, demonstrates it’s success in other communities, and presents testimonials from different stakeholders (right).

We also produced a short promotional recruitment video from the perspective of a USPS worker who had overcome his skepticism and been retrained as a community health outreach worker in his community.

We wrote a script (right) that specifically addressed some of the obvious potential pitfalls of our concept (like how it would be logistically integrated into the USPS system), as well as highlight the concepts strengths (shifts in how success/performance is measured at USPS).

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Thanks to USPS staff on campus, we were able to stage some of the scenes in a real postal facility and recruited a real postal worker to star in it (above).

We assigned ourselves organizational roles at USPS+ and each wrote a paragraph of talking points to guide our conversations with forum attendees (right). We made sure that our explanations were congruent, and that we focused on information that would sell our concept from multiple different stakeholder perspectives.

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10 | Presenting (in 2029)

Our presentation started with a 3-minute problem framing teaser presentation. We introduced ourselves in character, and welcomed the audience to the “11th Annual Places & Postal Form” as if we were in 2029.

After presentations, attendees broke out into groups to interact with the four different student booths. We welcomed attendees to our booth as if they were residents of Greene County, explained our different organizational roles at USPS+, presented a short recruitment video (below), handed out our brochure and flyer, and answered questions from the audience in character.

The day ended with a collaborative ideation session that drew on the collective cross-sector industry knowledge in the room to come up with more ideas for how postal networks might fortify communities. Breakout groups used a newspaper from the future template to tell a scrappy story from their preferred postal futures and pitched these back to the rest of the group.

Our USPS+ pitch from the future was a great success. USPS representatives, Pittsburgh city officials, and everyone in between, were bought in, interested, and curious to know more. Feedback included:

  • It’s clear how the concept would be socially and economically beneficial from both a community healthcare perspective and a USPS perspective.

  • The USPS+ concept might integrate well with current and emerging telehealth initiatives and technologies.

  • Alternative funding and business models might exist outside of the Medicaid funding model we proposed. One attendee commented that he would happily pay a subscription fee for his mother to be regularly checked in on.

  • Issues of data and privacy would be the biggest policy hurdles to implementation.

  • The CIO of USPS appreciated that there was “...advocacy in the essence of all your projects” in relation to to the fact that we were pushing for policy change outside of USPS, and not just inside.

  • The potential impact is clear and compelling: David Williams, the former Inspector General at USPS and current Vice-Chair of the Board said:

“These are dangerous ideas.

They are dangerous to say no to because they are so compelling….. [this concept] would have saved my mother’s life.”

 

REFLECTIONS

This project has been a fruitful exploration into the future of postal networks, and how they might be leveraged to fortify communities. Here are some of our reflections having completed the project:

• We produced many artifacts during our MediPost phase that weren’t all necessary. Some of these helped us gain clarity of how the service played out in reality, and helped translate our idea to others for critique – but the breadth of things we produced during that initial sprint perhaps wasn’t so necessary.

• When we shot the video with real USPS workers at the campus post office, they had rich insights to share in relation to our concept. We would have liked to talk to workers earlier on in the process to help inform our final concept and give the story more depth.

• We were very glad to have told our story from the future when we presented at the forum. We sensed the strong impact this had on participants, and would have especially liked more time to develop our concept video more.

• The hardest questions to answer at the forum related to HIPAA privacy laws. We would have like to do more research on this in anticipation of those questions.