End-Stage Renal Disease (ESRD) Ecosystem

Objective

To define the current state end-stage renal disease (ESRD) ecosystem of people, processes, and systems and represent this understanding of each so teams can be better equipped to identify and solve the right problems more efficiently.

Problem

CMS CCSQ product and program teams, being so focused on their immediate work, that they sometimes do not always understand how their work influences and is influenced by other groups (i.e., people), systems, policies, and processes that may or may not be something they can control. This lack of a shared understanding impacts the efficacy of their work. Some of the symptoms of this problem include:

• Stakeholders are unaware of the overall architecture of the ecosystem and the connections within it.
• Broken communication, not knowing where to go/what resources and services exist
• Stakeholders are unaware of the magnitude of the problem and do not understand the full picture
• Stakeholders only have a partial myopic "inside-out" view, but need to gain a holistic customer-centric view

Solution

The goals of this project include:

• EQRS stakeholders reach consensus about the people, process, policy, and systems that define the ecosystem
• EQRS communication is more effective across groups
• An artifact is created as a starting point to visualize the defined ecosystem
• Stakeholders gain a customer-centric view of this ecosystem
• Stakeholders leverage this viewpoint to identify customer needs and pain points and use human-centered design methods and activities to drive innovative solutions

The milestones of this project include:

• Met with EQRS project leadership to understand the problem
• Created a project brief to outline the who, what, where, when, and why for all project stakeholders
• Planned and prepared for 6 discovery workshops meant to define the ecosystem
• Due to limited participation and lacking key representation, the team pivoted to shorten the number of workshops and reduced participants to a smaller core team
• Identified and defined 7 entities in the ecosystem
• Added details to these 7 entities and validated these details
• Created the ESRD Ecosystem map (Download the Map)
• Created and deployed a wrap-up survey to get project feedback from the client

Lessons Learned

SUCCESSES

• Project Brief was a critical resource to achieve a shared understanding of project goals
• Great working relationship with the core project team
• Ability to secure participation commitments from subject matter experts (SMEs)
• Clearly defined roadmap for mode of discovery and number of discovery sessions
• Preparation and planning for kickoff meeting, workshops, and facilitation of workshops
• Visual artifact was well-received by the client  (Download the Map)
• Use of technology to simulate in-person engagement for remote attendees

CHALLENGES

• Limited participation by some key SMEs
• Inability to include a comprehensive representation of people in the ecosystem
• The project did not demonstrate a true human-centered design approach 
• Participants did not always have the bandwidth to complete "homework" outside of scheduled workshop events
• Remote participants had greater difficulty staying engaged