Hacking the Bureaucracy to Help Veterans

How a Veteran-centric approach can improve digital access to VA services and benefits

We first met sitting around a table on a frigid Friday morning at Harvard’s Innovation Lab. We knew the class that brought us together—Tech and Innovation in Government—wouldn’t be easy, but we had no idea what was in store for us. Over the next three months, our team of three Harvard students would conduct more than one hundred in-depth interviews with US Veterans as we built and rebuilt an app prototype for one of America’s biggest government agencies, the U.S. Department of Veterans Affairs (VA). By our last meeting, we would be scattered around the globe in a pandemic, sharing our work with senior VA decision makers.

The first day of DPI663—where our journey started

The first day of DPI663—where our journey started

The VA is a massive bureaucracy that faces the understandable challenges that come with delivering a wide range of benefits and services to nine million Veterans. Even so, the VA has a rich history of innovation. They developed the nicotine patch and implantable cardiac pacemaker, and even pioneered electronic medical records. In 2018 the Department revamped its digital presence, moving to a more streamlined and user-centric website that has received significant praise. Still, our partners at the VA—Presidential Innovation Fellows C.C. Gong and Clarice Chan and Chief Technology Officer Charles Worthington—asked our team to look for ways to further improve the online experience, noting that 40% of the new website’s traffic came from mobile devices.

Our first class left us wondering how we would ever contribute in a meaningful way. We weren’t veterans, we hadn’t received VA services, and we weren’t even aware of all of the benefits the VA offers. Furthermore, two of us had absolutely no digital experience, and we were partnering with a team at the VA whose members had previously worked at top tech companies like Facebook and Microsoft. But it turns out our professor, Nick Sinai, knew something we didn’t: our inexperience would be our biggest strength. It forced us to hit the pavement and hear from Veterans themselves. 

We started by talking to every Veteran we could find. We connected with local Veterans organizations, worked our personal networks, canvassed at the local VA hospital, and even interviewed our Uber driver on our way to a Veterans brunch. We asked Veterans about their experience with the VA, what was working, and what changes they would like to see.

A Veteran Uber driver showing us his phone (phone screen is pixelated for privacy)

A Veteran Uber driver showing us his phone (phone screen is pixelated for privacy)

While there is no “typical” Veteran—more than 9 million Veterans receive services ranging from home loans to medical insurance to job training—we found that many share the same frustrations. Chief among these difficulties was a sense of disjointedness when working with the VA, trouble finding answers to their questions, and uncertainty around which benefits they are eligible to receive. Check out our previous blog post to learn more about our field research with Veterans.

Our research yielded three areas where Veterans are frustrated with their digital experience

Our research yielded three areas where Veterans are frustrated with their digital experience

Talking to Veterans also allowed us to identify areas where the VA could take action to improve the Veteran digital experience. Veterans young and old, tech-savvy and tech-challenged alike, asked for many of the same features. Leading these “potential gains” were 1) managing medical appointments, 2) communicating with doctors, 3) eligibility determinations, and 4) quick access to documents.

We suggested four ways to improve the Veteran digital experience

We suggested four ways to improve the Veteran digital experience

Our data strongly suggested that, although the VA has made significant improvements to the Veteran digital experience, developing a mobile solution could greatly enhance these existing efforts. Our team explored several options, and debated the trade-offs between continuing to improve the website for mobile browsers, building a “progressive web app,” and building a “native app.”  (A native mobile app is made specifically for a smartphone or tablet—chances are that all, or almost all, of the apps on your phone are native apps.)

We concluded that the native app would be able to best deliver the most-requested functions to Veterans – things like push notifications, the ability to upload a test result or application through the camera, and all-around ease of use and streamlined user experience. It didn’t matter that we didn’t have personal experience navigating the VA—we let Veteran needs guide our thinking. 

As soon as we decided to build a prototype app, we faced another seemingly insurmountable challenge. The COVID-19 virus was spreading worldwide, forcing part of our team, Jeremiah and Taylor, into their Boston apartments. Our other team member, Lien, headed back home to Vietnam, where she had to spend two weeks in a quarantine camp. Though our new time zones pushed our meetings to late nights and early mornings, we didn’t miss a beat and got right to work using Balsamiq to create “wireframes,” or simplified visual representations of the app’s layout, and “prototypes,” which simulate what can happen when people interact with the app.

One of our very first paper prototypes

One of our very first paper prototypes

As we started developing the app, we kept in mind what one Veteran had warned us early on in our interviews: “don’t make an app for its own sake. Make sure it’s reliable.” Unless we provided the right balance of form and function (making sure that Veterans could do what they needed to do without being bombarded by extra information or options), we would be in danger of making Veterans’ current frustrations worse, not better.

A snapshot at one of our multiple online collaboration boards

A snapshot at one of our multiple online collaboration boards

Striking this right balance would take multiple rounds of feedback and refinement—we knew we weren’t going to get it right the first time (and we didn’t). Below, you can see our first prototype, with the buttons we thought Veterans would want in the order we thought they’d want them. Our first round of “user testing”—letting Veterans use the app while we watched and asked questions over Zoom—quickly shattered our assumptions of what features Veterans wanted and in what order. In response we took the buttons off the homescreen entirely for our second prototype and instead asked Veterans what they wanted, and in what order. We let Veteran input guide our design so that our “finished product” (on the far right below) was a direct reflection of Veteran feedback. Because each Veteran had their own idea of what they wanted to do with the app and how they wanted to do it, the order that we had imposed on them in the first prototype eventually became a “Quick Actions” section where each Vet could put whichever buttons they wanted at their fingertips.

How our prototypes changed after several iterations

How our prototypes changed after several iterations

Our final prototype lets Veterans do a lot: they can make medical appointments, communicate with their medical team, determine their eligibility, manage and review their benefits, access and upload their paperwork, and set up notifications and reminders. Just as important as the actual features was the user experience, and we knew we’d struck the right balance when we heard Allen’s comment, below:

While the end of the semester is our team’s finish line, the VA’s work continues to meet Veterans where they are—which is, increasingly, on their smartphones. Our partners at the VA were kind enough to schedule a (remote) roadshow for us, during which we had the honor and privilege of presenting our findings to a wide set of stakeholders at the VA, including James Gfrerer (Chief Information Officer at VA), VA executives, and the team that’s now getting underway with the development of such an app. 

None of this work would have been possible without the dedication of the VA team, which provided us with just the right amount of help at all the right times. Despite the guidance and support they provided, they were careful to leave us free to follow our own path, guided by the voices of the many Veterans we spoke with. We believe the project was better for it, and they have our sincere thanks.

In three months, our team endured a pandemic, worked through five different app prototypes, and got feedback from over a hundred different Veterans. Though we came in with little knowledge of the VA, our intense focus on understanding Veteran experiences allowed us to gain valuable insight into their needs and how the VA might best address them. We’re excited to pass our findings to the internal team that is ensuring the VA moves forward in their mission to provide America’s Veterans with the benefits and services they’ve earned.

-Jeremiah Hay, A. Taylor Thomas, Lien Tran

Should the VA Build a Mobile App? What 64 Veterans Taught Us

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As part of our research, we talked to Veterans at a local Boston ceremony honoring those who fought in the Vietnam War.

(This post is the second part of an ongoing series about a team of Harvard students’ efforts to help the VA build resources for the future. You can find the first post here.)

 

“You have to navigate through five or six different stages to get to where you need…[but] I like it. You can set your own appointments, refill prescriptions--all right here.” Steve, an 80-year-old Veteran, pointed to his iPhone.

Steve had ushered us into the hallway, away from the noise of the honorary Veteran’s event we were at, to make sure we caught every word of his feedback about the VA’s website. He spoke excitedly and at great length about how much he loved the site, which was a bit of a surprise: we’d heard from other Veterans about difficulties getting needed information, frustrations related to logging in over and over, and confusion around which benefits they were eligible for. But none of this mattered to Steve – he loved what the site offered.

Steve is one of the more than 40% of visitors to VA.gov who visit the site from a smartphone or tablet, and he didn’t seem to mind at all that the site isn’t optimized for use on mobile devices. But there are more than nine million Veterans receiving benefits from the VA – did other Veterans share his experiences? Should we streamline the several stages Steve had mentioned? Should the VA build a mobile app? We would need to talk to as many Veterans as we could to get to the bottom of this.

We found Steve, and the honorary brunch for African-American Veterans, through a Veteran Service Organization (one of many organizations in Boston and across the country that advocate for Veterans’ benefits and help them navigate what can be a complex system). We met several Veterans through our outreach to such organizations, including Carl, an older Veteran who expressed having a hard time finding what he needed on the website. “There was a lot of searching...you had to know where you were.” 

Already two Veterans mentioned the many steps and searching involved in navigating the website. A mobile app-- a pared down version of the website-- could certainly ease navigation. But do Veterans have other needs? What other themes would emerge?

 

These are some of the public events we attended in our quest to learn from Veterans.

These are some of the public events we attended in our quest to learn from Veterans.

In our mission to speak to as many Veterans as possible, we set out to the VA hospital in hopes of catching a spare minute of Veterans’ time while they waited for appointments, tests, and shuttles. When we arrived at the Jamaica Plain VA Medical Center, beyond the bustling white coats and hospital staff, we saw a cozy enclave where some elderly Veterans lounged in armchairs...and most of them were on their smartphones.

Even though these folks had a surprisingly wide range of experiences and preferences, several topics continued to resurface throughout our conversations. We interviewed several Veterans like Andy who, while tech-savvy, said the “multiple logins [on the website] are confusing,” and all the protections can be a headache, explaining, “every time I log in there is some password reset I have to do.” Still others spoke about the need to look up appointment details while on the go, and their inability to access this information quickly from their phone.

We even heard from some Veterans like Nate, who doesn’t have a smartphone or computer and prefers to communicate with the VA over the phone or in-person. Yet, of the veterans we spoke with who did use the website (we did 35 interviews in all), it became clear that there was indeed room to improve online services to better meet Veterans’ individual needs, and that an app just might be the solution. 

 

We were greeted with kind smiles and patience everywhere we went, like this ceremony honoring Vietnam War Veterans and their families in South Boston.

We were greeted with kind smiles and patience everywhere we went, like this ceremony honoring Vietnam War Veterans and their families in South Boston.

But most of our in-person interviews had netted older Veterans (who had fought in Vietnam or even World War II), and we wanted to balance their perspectives with the experiences of younger, more tech-literate Veterans (who might have fought in Desert Storm, Iraq, and/or Afghanistan). To reach these folks, we designed an online survey and shared it not only with our new community organization partners in Boston, but also with Veterans on Reddit, a very active online community.

Our survey post in the Veterans group on Reddit, an active online community.

Our survey post in the Veterans group on Reddit, an active online community.

The 29 survey responses we received rounded out our knowledge of Veterans’ experiences with the VA online, and revealed a lot of common pain points and desires. Even younger, more tech-savvy veterans had difficulty navigating the website and accessing services. And most expressed desire for an easy way to manage appointments, access documents on-the-go, and communicate with healthcare providers.

So, should the VA build a mobile app? We certainly think so.

A distilled version of the website with basic, user-friendly functions that is easily accessible on-the-go sounds like the perfect solution. But will Veterans think so?

Our next step is to build prototypes of what a VA mobile app could look like and put them in front of Veterans to see if our ideas are as helpful as we think they are. We’ll learn from Veterans’ reactions, go back to the drawing board, revise our prototype, get more feedback, and so on – iterating until we hammer out a solution that we think can best meet the needs of the most Veterans.

 

Stay tuned to see how our mobile app idea evolves as we get more feedback from Veterans!

Harvard Students Partner with the VA to Explore Next Steps for their Digital Experience

It’s the rare topic that Donald Trump and Alexandria Ocasio-Cortez agree on: no, the VA isn’t broken. In fact, a 2018 study showed the VA provides better healthcare than private hospitals in most cases.

This should come to no surprise, given VA’s rich history of innovation and groundbreaking achievements-- the VA has been home to several nobel laureates, and revolutionary technologies like the nicotine patch and first implantable cardiac pacemaker were invented there. And the VA digital team has been no exception. The VA pioneered electronic medical records, and launched a new website in 2018.

Even so, the digital experience could still be improved. Veterans continue to have challenges accessing the information they need, getting appointments quickly, and knowing how to use the benefits and services they’ve earned through their service.

Interestingly, almost half (40%) of the visitors to VA.gov are using mobile devices like smartphones and tablets, but the site isn’t optimized for that. What problems are Veterans still having with their digital experience? How can the VA— which provides benefits to more than 9 million Veterans and runs America’s largest healthcare system— continue to solve those problems? These are the questions that we’re trying to solve over the next couple of months.

Who are we? Glad you asked.

Our team was formed at the Harvard Kennedy School (HKS) as part of a field class taught by Nick Sinai, former U.S. Deputy Chief Technology Officer, to work with the U.S. Department of Veterans Affairs.  We’re working with VA CTO Charles Worthington and his team, and are excited to work across the VA. We bring unique strengths:

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A. Taylor Thomas is an MD/MPH student currently studying Health Management at Harvard. Prior to pursuing a career in healthcare, Taylor studied political science and worked as a staffer for Hillary Clinton's 2016 presidential campaign.

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Jeremiah Hay spent 4+ years before coming to HKS working on community outreach, admissions, and enrollment policy for New York City's universal pre-kindergarten program where he strengthened his innovation, systems integration, and stakeholder engagement skills.

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Lien Tran is a senior at Harvard College studying Computer Science and Linguistics. She brings to the team her experience in UX/ Product Design, software development, and conducting research in the field of Science and Engineering.

As we set out on this journey, we have more questions than answers. Why are Veterans using the website on their mobile devices? Does a dedicated mobile app make sense? What would it look like? What else can we try? Are there particular services and benefits we should focus on? These questions, and more, are what we’re asking ourselves as we get started with our research. 

Image source: https://www.uxpin.com/studio/blog/use-validated-learning-ux-design-2/

Image source: https://www.uxpin.com/studio/blog/use-validated-learning-ux-design-2/

Using the KJ method, we quickly determined and prioritized our design challenges

Using the KJ method, we quickly determined and prioritized our design challenges

We’re humbled by our lack of knowledge in this field (none of us are Veterans), and we know that in order to deliver results that would improve Veterans’ experiences, we need to talk to as many real-life Veterans as possible. At this early stage, our assumptions about the problems (let alone the solutions) are not only uninformed but dangerous— because they can overshadow what we’re hearing on the ground. Before anything else, we need to get in Veterans’ shoes and hear their stories from them.

We got moving by starting small and reaching out to Veterans among our friends and the Harvard community. We heard more than a couple stories that we hadn’t expected, which backed up our hunch that we didn’t know much.  

After these early conversations with friends and fellow students, we expanded our outreach to engage local Veterans organizations and online communities. We’ve already attended a handful of events, including a ceremony for Vietnam Veterans, which have been very useful in getting outside of our little Harvard bubble. We’ve also had success talking to Veterans at the nearby Jamaica Plain VA Hospital, where surprising numbers of generous Veterans have taken the time to patiently walk us through their experiences, teaching us what has worked well for them and where they’ve had frustration in the past.

We have many conversations ahead of us, and we’re planning on sending out an online survey to try to reach a different and more national audience (we’re also hoping to get our hands on the VA’s own website analysis). We’ll check back in to share what we’ve learned once we’ve heard a lot more from Veterans themselves. From there, we’ll get thinking about how we can help the VA deliver the world class digital experience Veterans deserve!

 

If you are a Veteran and want to chat about your digital experience with the VA, drop us a line at harvardvaresponses@gmail.com.