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Changing How We Care Innovating the dental care experience for under served communities in New York City

By Ali Baba Attaie and Liz Burow

Tooth decay in children is a big problem. Tooth decay is largely preventable, yet it remains the most common chronic disease among children and adolescents aged 6 to 191. For children from low-income communities, tooth decay is an even bigger prob-lem, as they carry a significantly larger disease load but have less access to care compared to more affluent communities. Pain from untreated tooth decay is so severe that it prevents millions of children from eating, sleeping and learning2. For communities with large disease loads, few solutions are being offered by the health care profession that are innovative enough to holistically address the root causes of this epidemic problem.

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Fixing vs. PreventingFor many socio-economically disad-vantaged families in the United States, access to dental care is impractical, costly, or inaccessible. In addition, many low-income communities consider a trip to the dentist as emergency treatment, rather then as a preventative measure.So, even when patients come in for

treatment, it doesn’t mean they’ll come back. In the communities that hellosmile serves in New York City3, on average, only twenty percent of patients return for regular check-ups. This creates a market for invasive ‘drill and fill’ treatment, where the dentists time is spent fixing existing problems, rather than trying to communicate how to prevent problems from occurring in the first place. A typical dental clinic in a low-income community runs on a business model that is 70% invasive treatment care and 30% preventative care.

Most Health Solutions aren’t Medical, They’re SocialIn order to tackle America’s most com-mon chronic childhood disease, we need to change how we care and invert the typical 70/30-business model to provide low-cost, efficient and effective preventa-tive health care solutions. At hellosmile, our solution is centred on a service blueprint grounded in prevention through 1) engaging children and families with patient-centred approaches, 2) empower-ing mid-level providers as oral health champions, and 3) connecting communi-ties through the exchange of information and collaboration among stakeholders. With these approaches, we work to build an ongoing dialog about healthy eating habits that effect not only oral health but

Ali Baba Attaie, DDS, FAAPD Director, Paedi-atric Dental Medicine, Mount Sinai Paediatric Dental and co-founder of hellosmile.Ali is a paediatric dental spe-cialist with active private and hospital-based dental surgery practices in New York City. He now works at a network of paediatric dental and medical clinics spread across Brooklyn, Queens and the Bronx, where innovative experiences help deliver high quality dental and medical care to all children.

Liz Burow is a design strategist who works with organisations to help them express their values through memorable experiences and spaces. She holds a Masters of Architecture from MIT, teaches visual thinking studios at Parsons School of Design in NYC and is currently a consulting creative director to hellosmile in NYC.

Health buddies participate in

Givesmile, our sister outreach

program that travels to day-cares,

churches, schools and health fairs

within neighbourhoods served by

the clinic, to teach kids and parents

about the importance of brushing,

visiting the dentist and eating

healthy snacks.

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By Ali Baba Attaie and Liz Burow

also the health and wellness of the entire body. Our goal is to create stronger, more self-reliant communities by designing conversations, spaces, incentives, prod-ucts and toys that are choreographed to create a ‘WOW!’ experience for our staff, our patients and their families.

Recruiting Local TalentTo create this experience, we focus on two areas that help our preventative care message stick: talent recruitment and customer retention. Our preventative-care business model is dependent on our patients and their families returning for regular check-ups and modifying health behaviours like brushing twice a day and finding alternatives to sug-ary snacks, based on conversations with our health-care providers. To do this, our patients must have a trusting and engaging relationship with hellosmile from the very first phone call and all the way through to each fond farewell.

In our service blueprint, the person

most empowered to help communicate the importance of preventative care is the hello buddy. The hello buddy, a mid-level provider and registered dental assistant, ‘hosts’ the child and parent at the clinic to make sure they have a comfortable and engaging experience, encourages behavioural change through education and information sharing and provides a wide range of preventative oral treatments under the guidance of an attending dentist. In this new clinical business model, we find that emphasising the role of hello buddies lowers the treatment cost under the supervision of dental professionals.

Creating charismatic hello buddies puts particular emphasis on cultural sensitivity, recruitment and the professional development of our mid-level provider. Our model is based on the idea that patients are more likely to listen to a provider who seems familiar and similar to them. Our recruitment is founded on an entry-level work force typically

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hired from the neighbourhoods that the hellosmile clinic serves. Such mid-level providers are more motivated to provide preventative dental services than the dentists, whose primary focus is to treat active acute disease. To further align the needs, perceptions and understanding between patients and providers, courses and on-the-job training are co-created and co-taught with employees, doctors, team leaders, IT professionals and designers . Workshops help our staff understand their ‘hosting’ responsibilities and assist in active patient/family engagement. In addition, outreach and volunteer opportunities empower staff to become community change agents and health ‘champions’ beyond their time as employees of hellosmile.

Rewarding MembershipHello buddies engage and motivate our patients to return for regular check-ups by enrolling patients as members of our Passport Incentive Program. The program is a series of conversations and incentives that

Developing a sequenced narra-

tive helps guide our ‘hosting’

staff through important touch-

points and conversations.

Health buddies participate in

Givesmile, our sister outreach

program that travels to day-

cares, churches, schools and

health fairs within neighbour-

hoods served by the clinic, to

teach kids and parents about

the importance of brushing,

visiting the dentist and eating

healthy snacks.

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By Ali Baba Attaie and Liz Burow

are expressed through the design of our clinics that include the spaces, toys, graphics, products and interactions with patients. At the centre of the program is the hellosmile Passport, which acts like a membership rewards card and is given to children upon their first visit. For the hello buddy, the Passport Program provides a series of conversational prompts and props to engage parents in chair-side discussions about the causes of dental disease, the importance of brushing and eating tips that promote better oral health. Most importantly, the Passport Program creates a reward for returning for the next preventative visit: small prizes for coming to scheduled appointments that culminate in a raffle

ticket for a quarterly grand prize draw. Prizes like Nintendo Wii gaming consoles are selected for their popularity as well as to encourage physical activities shared between parents and children.

Providing a Hub for Service Design ThnkingWe strongly believe that service design thinking can change the healthcare landscape within underserved and low-income communities. Until now, most design services have not penetrated this market, due, in part, to a client perception that ‘design’ is costly, unnecessary or inaccessible. In response, we have established hellolab, a non-profit innovation lab that brings together

The hellosmile Passport

documents check-up

attendance, and facili-

tates conversations

around healthy eating

and brushing habits.

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business leaders, designers and health care professionals into a studio setting where people can work, meet and share data, ideas and sketches as they research and develop appropriate service models . Hellolab’s objective is to make design accessible and affordable to communities who can greatly benefit from design strategy and service design thinking.

ServiceDesign Thinking as ‘Social Glue’Our vision is to help eliminate childhood tooth decay in every community served by hellosmile. While our goals are big, each project begins with a conversation where we look at ‘bits’. Service design thinking helps us understand how all the ‘bits’ come together as a whole

experience and why it matters. The tools and techniques of service design, like creating personas, storyboarding, experience prototyping, role-playing and affinity mapping help facilitate more constructive, user-focused conversations between our multi-disciplinary team members and help us figure out how to make our ideas happen. Service design helps us turn our spreadsheets into sketches of efficient systems and inspiring experiences and then, eventually, back into spreadsheets as we gather more data, evidence and experience. We hope to see more service-driven innovations and effective problem solving that address the needs of under-served communities, in our community and in yours. •

References1 According to the U.S. Center for Disease Control and Prevention

2 Oral Health in America: A Report of the Surgeon General, National Institute of Dental and Craniofacial Research, National Institutes of Health, U.S. Department of Health and Human Services (DHHS), 2000.

3 hellosmile PMG has clinics in Woodside, Sunnyside, Corona, Jackson Heights, North Central Bronx and Parkslope and treats an average of 2000 of children/month.